Individual
DR. CASSIANNE SUMMERLIN BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
708 MOBJACK PL, NEWPORT NEWS, VA 23606-1957
(757) 873-1958
(757) 873-2143
Mailing address
708 MOBJACK PL, NEWPORT NEWS, VA 23606-1957
(757) 873-1958
(757) 873-2143
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810001464
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056563
ANTHEM BC/BS
VA
01
—
080925
SENTARA
VA
01
—
219661
MAMSI
VA
Enumeration date
06/30/2006
Last updated
07/08/2007
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