Healthcare Provider Details

I. General information

NPI: 1619635133
Provider Name (Legal Business Name): KASSANDRE J CLAYTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASSANDRE JEANETTE CLAYTON LCSW

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 QUEBEC AVENUE COMPLEX IV G-2 ROOM #153
CORCORAN CA
93212
US

IV. Provider business mailing address

1250 E SHAW AVE APT 162
FRESNO CA
93710-7826
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-7100
  • Fax:
Mailing address:
  • Phone: 559-412-2951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number81496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: