Healthcare Provider Details

I. General information

NPI: 1497131783
Provider Name (Legal Business Name): CASSANDRA LOPIANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5149 S 1500 W
RIVERDALE UT
84405-3926
US

IV. Provider business mailing address

5149 S 1500 W
RIVERDALE UT
84405-3926
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-0402
  • Fax: 801-475-7464
Mailing address:
  • Phone: 801-475-0402
  • Fax: 801-475-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9806344-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: