Active NPI
Cassandra Mary Nicotra
- Child & Adolescent Psychiatry Physician
- Philadelphia, PA
National Provider Identifier
1538684725
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- OS023869
- Practice address
- 3401 Civic Center Blvd
Philadelphia, PA 19104-4319 - Phone
- (215) 590-6267
- NPI assigned
- Aug 8, 2017
- Reactivated
- Aug 6, 2018
- Last updated
- Aug 12, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | OS023869 | PA | Primary |
Addresses
Primary practice location
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Mailing address
2609 SE 21St PL
Cape Coral, FL 33904-3275
Phone (239) 410-5601
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS023869 | PA | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723420800000",
"number": "1538684725",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2609 SE 21ST PL",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339043275",
"telephone_number": "239-410-5601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044319",
"telephone_number": "215-590-6267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOTRA",
"first_name": "CASSANDRA",
"middle_name": "MARY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-08",
"last_updated": "2024-08-12",
"certification_date": "2024-08-12",
"deactivation_date": "2018-05-02",
"reactivation_date": "2018-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "PA",
"license": "OS023869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.