Provider Demographics
NPI:1902646425
Name:PORTER, CASSIE (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-1853
Mailing Address - Country:US
Mailing Address - Phone:973-356-4897
Mailing Address - Fax:
Practice Address - Street 1:200 PARK AVE
Practice Address - Street 2:
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-1853
Practice Address - Country:US
Practice Address - Phone:973-356-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ990692103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool