Provider Demographics
NPI:1053569434
Name:LATERZA, CASSANDRA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MARIE
Last Name:LATERZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 GATEWAY BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7401
Mailing Address - Country:US
Mailing Address - Phone:650-616-2576
Mailing Address - Fax:833-522-0986
Practice Address - Street 1:801 GATEWAY BLVD FL 4
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7401
Practice Address - Country:US
Practice Address - Phone:650-616-2576
Practice Address - Fax:833-522-0986
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical