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NPI Code Detail

MEDICARE: SASHA D FASSETT LICENSED CLINICAL SOCIAL WORKER PC

MEDICARE: SASHA D FASSETT LICENSED CLINICAL SOCIAL WORKER PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerR069367-1NY

General Provider Information

NPI Number : 1033457163
Entity Type Code : Organization
Provider Name (Legal Business Name) : SASHA D FASSETT LICENSED CLINICAL SOCIAL WORKER PC
Provider Business Mailing Address
First Line : 217 JEFFERSON AVE
Second Line :
City : ENDICOTT
State : NY
Zip : 13760-5244
Country : US
Telephone Number : 607-237-5411
Fax Number :
Provider Business Practice Location Address
First Line : 217 JEFFERSON AVE
Second Line :
City : ENDICOTT
State : NY
Zip : 13760-5244
Country : US
Telephone Number : 607-237-5411
Fax Number :
Authorized Official
Title or Position : LICENSED CLINICAL SOCIAL WORKER
Name : SASHA D FASSETT
Credential : LCSW-R
Telephone Number : 607-237-5411
Provider Enumeration Date : 01/24/2013
Last Update Date : 01/24/2013

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Directions to “SASHA D FASSETT LICENSED CLINICAL SOCIAL WORKER PC ” Practice Location

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