Provider Demographics
NPI:1316279854
Name:OLIVER, CASSANDRA N (MSW, LISW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:N
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 UNION ST
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3919
Mailing Address - Country:US
Mailing Address - Phone:740-349-7066
Mailing Address - Fax:
Practice Address - Street 1:195 UNION ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3919
Practice Address - Country:US
Practice Address - Phone:740-349-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-09001391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1376607374OtherORGANIZATION NPI#
OH10193Medicaid