=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114781887
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASSANDRA SCOTT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2024
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5923 KANAN RD
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-1688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-866-2606
-----------------------------------------------------
Fax | 310-455-1416
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3857 BIRCH ST # 3223
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-2616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-274-9812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 126702
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------