MEDICARE: CASSANDRA SIERRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	3284	FL

General Provider Information

NPI Number	:	1396073508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA SIERRA

Provider Business Mailing Address
First Line	:	5551 N WINSTON PARK BLVD APT 108
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-5042
Country	:	US
Telephone Number	:	954-420-9095
Fax Number	:	954-420-9095

Provider Business Practice Location Address
First Line	:	12794 W FOREST HILL BLVD
Second Line	:	SUITE 18G
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4710
Country	:	US
Telephone Number	:	561-795-1518
Fax Number	:	561-795-1629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2009
Last Update Date	:	11/28/2009

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Directions to “ CASSANDRA SIERRA ” Practice Location

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