Provider Demographics
NPI:1831511203
Name:ACKERMAN, CASSANDRE (LCSW)
Entity type:Individual
Prefix:
First Name:CASSANDRE
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3997 S NOVA RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9296
Mailing Address - Country:US
Mailing Address - Phone:386-761-7961
Mailing Address - Fax:386-763-2150
Practice Address - Street 1:DAVITA DIALYSIS
Practice Address - Street 2:3997 SOUTH NOVA ROAD
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-1230
Practice Address - Country:US
Practice Address - Phone:386-761-7961
Practice Address - Fax:386-763-2150
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 84941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical