Provider Demographics
NPI:1104093582
Name:KASSOVER, KATHI A
Entity type:Individual
Prefix:MS
First Name:KATHI
Middle Name:A
Last Name:KASSOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHI
Other - Middle Name:A
Other - Last Name:KASSOVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW BCD
Mailing Address - Street 1:125 MINEOLA AVE
Mailing Address - Street 2:107
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2023
Mailing Address - Country:US
Mailing Address - Phone:516-484-7020
Mailing Address - Fax:516-484-7021
Practice Address - Street 1:125 MINEOLA AVE
Practice Address - Street 2:107
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2023
Practice Address - Country:US
Practice Address - Phone:516-484-7020
Practice Address - Fax:516-484-7021
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-026473-1101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist