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General NPI Number Information
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NPI Number | 1821603929
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Entity Type | Individual
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Provider Name | CASSANDRA LAWSON
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Gender |
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 5201 GREAT AMERICA PKWY STE 320
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City | SANTA CLARA
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State | CA
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Zip | 95054-1140
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1214
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City | COSTA MESA
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State | CA
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Zip | 92628-1214
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY35618
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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