Healthcare Provider Details

I. General information

NPI: 1568658706
Provider Name (Legal Business Name): CATHERINE CASCILLE HAMPTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASCILLE ANDELA LCSW

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24302 NORTHERN BLVD
DOUGLASTON NY
11362-1150
US

IV. Provider business mailing address

24302 NORTHERN BLVD
DOUGLASTON NY
11362-1150
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-6200
  • Fax: 718-423-9762
Mailing address:
  • Phone: 718-423-6200
  • Fax: 718-423-9762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074303-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079440-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: