Provider Demographics
NPI:1447029681
Name:CASADY, CHEYENNE MICHELE (LCSW)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:MICHELE
Last Name:CASADY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:MICHELE
Other - Last Name:CASADY TATUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 W LEMON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13500 LIVE OAK ST APT 82
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-0504
Practice Address - Country:US
Practice Address - Phone:325-864-1639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1244181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical