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General NPI Number Information
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NPI Number | 1578223848
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Entity Type | Individual
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Provider Name | JOANNE EILEEN CASSERLY
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Gender | Female
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 817 E RIO GRANDE ST
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City | PASADENA
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State | CA
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Zip | 91104-5044
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Country | US
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Telephone | 323-528-9856
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40494
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City | PASADENA
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State | CA
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Zip | 91114-7494
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Country | US
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Telephone | 323-528-9856
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW20601
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License Number State | CA
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