Healthcare Provider Details

I. General information

NPI: 1841527439
Provider Name (Legal Business Name): ANDRIA CASSEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 E 17TH ST
CHEYENNE WY
82001-4612
US

IV. Provider business mailing address

13312 CLOUD MESA DR
CHEYENNE WY
82009-8675
US

V. Phone/Fax

Practice location:
  • Phone: 307-421-5797
  • Fax: 307-635-3965
Mailing address:
  • Phone: 307-421-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-728
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: