Healthcare Provider Details

I. General information

NPI: 1598444911
Provider Name (Legal Business Name): CASSANDRA BROOKE LANDRETH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA BROOKE DENZLER

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 E LOOCKERMAN ST STE 306
DOVER DE
19901-8305
US

IV. Provider business mailing address

8020 PISTACHIO PL
DOVER DE
19901-5929
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-2700
  • Fax:
Mailing address:
  • Phone: 765-524-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberQ3-0011257
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: