Provider Demographics
NPI:1730679556
Name:MARTIN-WEILER, CASSANDRA JUANITA
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:JUANITA
Last Name:MARTIN-WEILER
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 1:450 N BRICE RD UNIT 133
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-1507
Mailing Address - Country:US
Mailing Address - Phone:614-329-6218
Mailing Address - Fax:
Practice Address - Street 1:11630 BROAD ST SW
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8195
Practice Address - Country:US
Practice Address - Phone:614-329-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS272211041C0700X
OHI.2203764-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical