Healthcare Provider Details

I. General information

NPI: 1881715415
Provider Name (Legal Business Name): CASSIDY RAE MANTON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 N GLASSELL ST
ORANGE CA
92867-6748
US

IV. Provider business mailing address

594 N GLASSELL ST
ORANGE CA
92867-6748
US

V. Phone/Fax

Practice location:
  • Phone: 562-546-3172
  • Fax:
Mailing address:
  • Phone: 562-546-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 47286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: