Healthcare Provider Details

I. General information

NPI: 1356630024
Provider Name (Legal Business Name): CASSANDRA HERBERT APRN/PMH-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5026 DORSEY HALL DR SUITE 205
ELLICOTT CITY MD
21042-7852
US

IV. Provider business mailing address

3756 ANGELTON CT
BURTONSVILLE MD
20866-2059
US

V. Phone/Fax

Practice location:
  • Phone: 410-415-1454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR148305
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR148305
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: