Healthcare Provider Details

I. General information

NPI: 1174516470
Provider Name (Legal Business Name): STEVEN B CASSEL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 NW 33RD AVE STE 221
FORT LAUDERDALE FL
33309-6376
US

IV. Provider business mailing address

5310 NW 33RD AVE STE 221
FORT LAUDERDALE FL
33309-6376
US

V. Phone/Fax

Practice location:
  • Phone: 954-234-0622
  • Fax: 954-345-5504
Mailing address:
  • Phone: 954-234-0622
  • Fax: 954-345-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPY3898
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY3898
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: