Provider Demographics
NPI:1730811605
Name:SMITH, CASSANDRA (MSW, LICSW, LADC)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 PORT GRACE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3190
Mailing Address - Country:US
Mailing Address - Phone:402-645-0038
Mailing Address - Fax:
Practice Address - Street 1:12110 PORT GRACE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3190
Practice Address - Country:US
Practice Address - Phone:402-645-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29151041C0700X
NE1596101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)