Provider Demographics
NPI:1063150969
Name:PETRO, CASSANDRA (LPCC)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:PETRO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 MENTOR AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5410
Mailing Address - Country:US
Mailing Address - Phone:440-701-6170
Mailing Address - Fax:440-527-8043
Practice Address - Street 1:398 W BAGLEY RD STE 13
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1312
Practice Address - Country:US
Practice Address - Phone:440-970-3790
Practice Address - Fax:440-527-8043
Is Sole Proprietor?:No
Enumeration Date:2022-05-22
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2404855101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty