Provider Demographics
NPI:1316786114
Name:VENDRAMIN, CASSIDY HARRIS (LMSW)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:HARRIS
Last Name:VENDRAMIN
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 1:6500 VEGAS DR APT 2017
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-7713
Mailing Address - Country:US
Mailing Address - Phone:219-476-6444
Mailing Address - Fax:
Practice Address - Street 1:5576 S FORT APACHE RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-3607
Practice Address - Country:US
Practice Address - Phone:702-287-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11478-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker