MEDICARE: MARILYN J CASSIS PHD

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	101YP2500X	Professional Counselor	125	WV
2	101YP2500X	Professional Counselor	965	WV
3	104100000X	Social Worker	CP00942504	WV
4	106H00000X	Marriage & Family Therapist	125	WV
5	101YP2500X	Professional Counselor	908	WV

General Provider Information

NPI Number	:	1346368461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARILYN J CASSIS PHD

Provider Business Mailing Address
First Line	:	1514 KANAWHA BOULEVARD EAST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311
Country	:	US
Telephone Number	:	304-345-1388
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 KANAWHA BOULEVARD EAST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311
Country	:	US
Telephone Number	:	304-345-1388
Fax Number	:

Authorized Official
Title or Position	:	OWNER MFT
Name	:	MS. MARILYN J CASSIS
Credential	:	PHD MFT
Telephone Number	:	304-345-1388

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	09/11/2025

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