Provider Demographics
NPI:1114370061
Name:TAVERNA, CASSANDRA JOAN (LCSW-A)
Entity type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:JOAN
Last Name:TAVERNA
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:CASSY
Other - Middle Name:
Other - Last Name:TAVERNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3240 BURNT MILL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2576
Mailing Address - Country:US
Mailing Address - Phone:910-790-9500
Mailing Address - Fax:
Practice Address - Street 1:3240 BURNT MILL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2576
Practice Address - Country:US
Practice Address - Phone:910-790-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0107811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical