MEDICARE: MS. AMY G. RASSEN LCSW

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	101YM0800X	Mental Health Counselor	4536	CA

General Provider Information

NPI Number	:	1376574830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY G. RASSEN LCSW

Provider Business Mailing Address
First Line	:	1545 N CASTLE RD
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-4864
Country	:	US
Telephone Number	:	415-359-1031
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 25TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-3612
Country	:	US
Telephone Number	:	415-751-1446
Fax Number	:

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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