MEDICARE: CASSIA MARIE LEENDERTSE LICSW

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	1041C0700X	Clinical Social Worker	089.0134725	VT

General Provider Information

NPI Number	:	1578412177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIA MARIE LEENDERTSE LICSW

Provider Business Mailing Address
First Line	:	2738 NORTH ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-9646
Country	:	US
Telephone Number	:	802-839-6360
Fax Number	:

Provider Business Practice Location Address
First Line	:	2738 NORTH ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-9646
Country	:	US
Telephone Number	:	802-839-6360
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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