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NPI Code Detail

MEDICARE: MRS. KATRINA ROSE CASSARA LMSW

MEDICARE: MRS. KATRINA ROSE CASSARA LMSW
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1770020802
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATRINA ROSE CASSARA LMSW
Provider Business Mailing Address
First Line : 11218 PRADO DEL REY LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89141-3921
Country : US
Telephone Number : 702-503-2841
Fax Number :
Provider Business Practice Location Address
First Line : 2121 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2205
Country : US
Telephone Number : 702-382-7746
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2017
Last Update Date : 08/31/2023

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