Provider Demographics
NPI:1083108765
Name:CARMICHAEL, CASSANDRA JO (LMSW)
Entity type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:JO
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-5215
Mailing Address - Country:US
Mailing Address - Phone:814-943-0414
Mailing Address - Fax:
Practice Address - Street 1:413 S LOGAN BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5643
Practice Address - Country:US
Practice Address - Phone:814-201-2750
Practice Address - Fax:814-201-2383
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
PASW142103104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW142103OtherSTATE BOARD OF SOCIAL WORKERS, MARRIAGE & FAMILY THERAPISTS AND PROFESSIONAL COU