Provider Demographics
NPI:1770060758
Name:CASSETTARI, LISETTE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISETTE
Middle Name:
Last Name:CASSETTARI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LISETTE
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:921 PASEO PALMERA
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-2057
Mailing Address - Country:US
Mailing Address - Phone:561-779-1009
Mailing Address - Fax:
Practice Address - Street 1:3450 NORTHLAKE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1711
Practice Address - Country:US
Practice Address - Phone:561-842-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist