MEDICARE: MRS. TRICIA DIANE CASSEL MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY8032	FL

General Provider Information

NPI Number	:	1184818098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRICIA DIANE CASSEL MS

Provider Business Mailing Address
First Line	:	5915 PONCE DE LEON BLVD
Second Line	:	SUITE 49
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2435
Country	:	US
Telephone Number	:	305-668-0355
Fax Number	:	305-668-5344

Provider Business Practice Location Address
First Line	:	5915 PONCE DE LEON BLVD
Second Line	:	SUITE 49
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2435
Country	:	US
Telephone Number	:	305-668-0355
Fax Number	:	305-668-5344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	01/07/2010

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