MEDICARE: MS. KRISTINA A CASSARA MSW, LSW

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	104100000X	Social Worker	44SL06377500	NJ

General Provider Information

NPI Number	:	1902394026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINA A CASSARA MSW, LSW

Provider Business Mailing Address
First Line	:	309 27TH ST S
Second Line	:
City	:	BRIGANTINE
State	:	NJ
Zip	:	08203-1811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3073 ENGLISH CREEK AVE STE 3
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-9711
Country	:	US
Telephone Number	:	609-652-1600
Fax Number	:

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

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	10/20/2023

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