Healthcare Provider Details

I. General information

NPI: 1215857701
Provider Name (Legal Business Name): CASSANDRA GERACE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S FRANKLIN AVE STE 3
VALLEY STREAM NY
11580-6105
US

IV. Provider business mailing address

1203 E BROADWAY
HEWLETT NY
11557-2426
US

V. Phone/Fax

Practice location:
  • Phone: 516-303-9925
  • Fax: 516-303-9920
Mailing address:
  • Phone: 203-400-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: