Healthcare Provider Details

I. General information

NPI: 1659955144
Provider Name (Legal Business Name): CASSONDRA DEL ROSARIO M.A., M.A., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date: 12/27/2021
Reactivation Date: 11/04/2022

III. Provider practice location address

5150 E PACIFIC COAST HWY STE 200
LONG BEACH CA
90804-3399
US

IV. Provider business mailing address

5150 E PACIFIC COAST HWY STE 200
LONG BEACH CA
90804-3399
US

V. Phone/Fax

Practice location:
  • Phone: 562-285-3542
  • Fax:
Mailing address:
  • Phone: 562-284-3542
  • Fax: 310-496-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC17992
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: