Provider Demographics
NPI:1740012764
Name:LONG, CASSANDRA R (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:R
Last Name:LONG
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N NECONI AVE
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-1443
Mailing Address - Country:US
Mailing Address - Phone:816-529-3860
Mailing Address - Fax:
Practice Address - Street 1:10881 LOWELL AVE STE 130
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1666
Practice Address - Country:US
Practice Address - Phone:913-386-6889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13797104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker