Provider Demographics
NPI:1326319369
Name:BARRY, CASSANDRA MN (SUDP BSW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MN
Last Name:BARRY
Suffix:
Gender:F
Credentials:SUDP BSW
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:MN
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SUDP
Mailing Address - Street 1:1902 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1155
Mailing Address - Country:US
Mailing Address - Phone:206-999-2615
Mailing Address - Fax:509-765-4124
Practice Address - Street 1:1902 2ND AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1155
Practice Address - Country:US
Practice Address - Phone:206-999-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CP60145093101YA0400X
WACP60145093101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)