Provider Demographics
NPI:1861876799
Name:MARBURY, KASANDRA (MSW,BSW,LMSW, LCSW)
Entity type:Individual
Prefix:
First Name:KASANDRA
Middle Name:
Last Name:MARBURY
Suffix:
Gender:F
Credentials:MSW,BSW,LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:30 PECK RD BLDG 2
Practice Address - Street 2:TORRINGTON CLINICAL SERVICES
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-626-7007
Practice Address - Fax:860-626-7014
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT93891041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT071OtherCONNECTICUT DEPT OF EDUCATION EDUCATOR CERTIFICATE-SCHOOL SOCIAL WORKER
CT008060377Medicaid
CT13671437OtherCAQH
CT060669107OtherANTHEM BCBS OF CT BEHAVIORAL HLTH-WELLMORE, INC GRP/FACILITY
CT060669107OtherUBH-CONNECTICARE- WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT13671437OtherCAQH
CT008060377Medicaid
CTPENDINGOtherMHN TRICARENORTH
CT071OtherCONNECTICUT DEPT OF EDUCATION EDUCATOR CERTIFICATE-SCHOOL SOCIAL WORKER
CT060669107OtherUBH-OXFORD/FREEDOM-OXFORD/LIBERTY WELLMORE GRP/FACILITY
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherHEALTHYCT- WELLMORE GRP/FACILITY
CTD339230-TORRINGTONOtherBEACON HEALTH STRATEGIES