Provider Demographics
NPI:1467268193
Name:HEENAN, CASSANDRA LEE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:HEENAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 BROADCASTING RD STE 203
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3221
Mailing Address - Country:US
Mailing Address - Phone:610-854-8281
Mailing Address - Fax:
Practice Address - Street 1:1220 BROADCASTING RD STE 203
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3221
Practice Address - Country:US
Practice Address - Phone:610-854-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health