Basic Information
| Provider Information | |||||||||
| NPI: | 1477148096 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALAREZO | ||||||||
| FirstName: | CASSANDRA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 OCEAN PKWY APT 5H | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112302721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3472452787 | ||||||||
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| Practice Location | |||||||||
| Address1: | 184 ELDRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100022992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124534522 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2021 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 110986-01 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 110986-01 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 110986-01 | 01 | NY | LMSW | OTHER |