Provider Demographics
NPI:1588917116
Name:CESPEDES CARRASCO, CASSANDRA ALEXIS (PSYD)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:ALEXIS
Last Name:CESPEDES CARRASCO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1456
Mailing Address - Country:US
Mailing Address - Phone:407-303-8877
Mailing Address - Fax:407-303-8811
Practice Address - Street 1:615 E PRINCETON ST STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1456
Practice Address - Country:US
Practice Address - Phone:407-303-8877
Practice Address - Fax:407-303-8811
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPPY267103T00000X
103TB0200X
FLPY10582103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral