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General NPI Number Information
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NPI Number | 1952128928
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Entity Type | Individual
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Provider Name | CASSANDRA MODICA MSW
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Gender | Male
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 205 N MICHIGAN AVE STE 810
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City | CHICAGO
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State | IL
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Zip | 60601-5902
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Country | US
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Telephone | 215-280-5589
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 CLARENDON AVE APT 42
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1938
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Country | US
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Telephone | 215-280-5589
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 105114317
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License Number State | IL
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