Provider Demographics
NPI:1518680479
Name:GROD, CASSANDRA NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:NICOLE
Last Name:GROD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-2031
Mailing Address - Country:US
Mailing Address - Phone:732-597-3440
Mailing Address - Fax:
Practice Address - Street 1:2290 W COUNTY LINE RD STE 105
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2267
Practice Address - Country:US
Practice Address - Phone:732-675-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00177800106H00000X
NJ44SC061246001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty