Provider Demographics
NPI:1841659398
Name:GOULDTHREAD, CASSANDRA (LSW)
Entity type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:
Last Name:GOULDTHREAD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BLACKBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WEEDVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15868-3510
Mailing Address - Country:US
Mailing Address - Phone:814-771-1343
Mailing Address - Fax:
Practice Address - Street 1:1759 TREASURE LK
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-9046
Practice Address - Country:US
Practice Address - Phone:814-771-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133130104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1841289733OtherUBH