Healthcare Provider Details

I. General information

NPI: 1013486661
Provider Name (Legal Business Name): MARK DANIEL CASSANO PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E. WOODLAND AVE STE 200
SPRINGFIELD PA
19064-3956
US

IV. Provider business mailing address

1260 E. WOODLAND AVE STE 200
SPRINGFIELD PA
19064-3956
US

V. Phone/Fax

Practice location:
  • Phone: 610-690-4490
  • Fax: 610-328-9391
Mailing address:
  • Phone: 610-690-4490
  • Fax: 610-328-9391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS018661
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: