Provider Demographics
NPI:1699120956
Name:KANE, KASSADRA MARIE
Entity type:Individual
Prefix:
First Name:KASSADRA
Middle Name:MARIE
Last Name:KANE
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 1:26 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2229
Mailing Address - Country:US
Mailing Address - Phone:978-578-0399
Mailing Address - Fax:
Practice Address - Street 1:26 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2229
Practice Address - Country:US
Practice Address - Phone:978-578-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-24
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health