Provider Demographics
NPI:1720828882
Name:PERRY, CASSANDRA NICHOLE (MSW, RCSWI)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:NICHOLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 SHEARWATER ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2692
Mailing Address - Country:US
Mailing Address - Phone:813-838-1768
Mailing Address - Fax:
Practice Address - Street 1:4024 SHEARWATER ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-2692
Practice Address - Country:US
Practice Address - Phone:813-838-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW19138104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker