Provider Demographics
NPI:1013898428
Name:RAMOS, CASSANDRA VINESSA
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:VINESSA
Last Name:RAMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 EATON RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3674
Mailing Address - Country:US
Mailing Address - Phone:973-832-5020
Mailing Address - Fax:
Practice Address - Street 1:12823 SOLOLA WAY
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-7246
Practice Address - Country:US
Practice Address - Phone:727-534-6042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1359303106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician