MEDICARE: MS. CASSANDRA YVETTE HENRY LCSW

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
1	1041C0700X	Clinical Social Worker	0904003517	VA

General Provider Information

NPI Number	:	1306953815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CASSANDRA YVETTE HENRY LCSW

Provider Business Mailing Address
First Line	:	14201 CASTLE BLVD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-4760
Country	:	US
Telephone Number	:	240-273-2647
Fax Number	:	301-847-0663

Provider Business Practice Location Address
First Line	:	14201 CASTLE BLVD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-4760
Country	:	US
Telephone Number	:	240-273-2647
Fax Number	:	301-847-0663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	04/01/2010

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