Provider Demographics
NPI:1881125060
Name:PROCENKO, CASSIANN (LICSW)
Entity type:Individual
Prefix:
First Name:CASSIANN
Middle Name:
Last Name:PROCENKO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 WALTON BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1413
Mailing Address - Country:US
Mailing Address - Phone:248-218-0622
Mailing Address - Fax:
Practice Address - Street 1:2490 WALTON BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1413
Practice Address - Country:US
Practice Address - Phone:248-218-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN204031041C0700X
MI68011091541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical