Healthcare Provider Details

I. General information

NPI: 1770020802
Provider Name (Legal Business Name): KATRINA ROSE CASSARA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATRINA SODERLUND-PAVON QBA

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 W CHARLESTON BLVD
LAS VEGAS NV
89102-2205
US

IV. Provider business mailing address

11218 PRADO DEL REY LN
LAS VEGAS NV
89141-3921
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-7746
  • Fax:
Mailing address:
  • Phone: 702-503-2841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: