Provider Demographics
NPI:1043853229
Name:CASSANDRA DAMM LLC
Entity type:Organization
Organization Name:CASSANDRA DAMM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:ALTHOFF
Authorized Official - Last Name:DAMM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:650-279-2464
Mailing Address - Street 1:3710 N WILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3916
Mailing Address - Country:US
Mailing Address - Phone:650-279-2464
Mailing Address - Fax:
Practice Address - Street 1:1608 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3048
Practice Address - Country:US
Practice Address - Phone:650-279-2464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)