1790283554 NPI number — CASSANDRA CHANCE DAVIDSON BLUM LCSW: CW025688

Table of content: CASSANDRA CHANCE DAVIDSON BLUM LCSW: CW025688 (NPI 1790283554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790283554 NPI number — CASSANDRA CHANCE DAVIDSON BLUM LCSW: CW025688

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLUM
Provider First Name:
CASSANDRA
Provider Middle Name:
CHANCE DAVIDSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW: CW025688
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790283554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3537 SPRUCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHAMPTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18067-9123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-707-1909
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLEETWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19522-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-578-9600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW025688 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CW025688 . This is a "LCSW" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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