Provider Demographics
NPI:1710371968
Name:NOVEMBRE, CASSANDRE ANTOINETTE (MSED)
Entity type:Individual
Prefix:
First Name:CASSANDRE
Middle Name:ANTOINETTE
Last Name:NOVEMBRE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W 101ST ST APT 6G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5032
Mailing Address - Country:US
Mailing Address - Phone:646-489-8764
Mailing Address - Fax:
Practice Address - Street 1:210 W 101ST ST APT 6G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5032
Practice Address - Country:US
Practice Address - Phone:646-489-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2529812171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator