Provider Demographics
NPI:1770727042
Name:WENDI CASSAND, LCSW, CAP, LLC
Entity type:Organization
Organization Name:WENDI CASSAND, LCSW, CAP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:CASSAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CAP, LLC
Authorized Official - Phone:954-650-1706
Mailing Address - Street 1:4821 NE 5TH TER
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2326
Mailing Address - Country:US
Mailing Address - Phone:954-650-1706
Mailing Address - Fax:954-267-9567
Practice Address - Street 1:4821 NE 5TH TER
Practice Address - Street 2:SUITE A
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-2326
Practice Address - Country:US
Practice Address - Phone:954-650-1706
Practice Address - Fax:954-267-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2428W101YA0400X
FLSW68331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764958400Medicaid
FL764958400Medicaid