Provider Demographics
NPI:1306214770
Name:AMANDA CASSIL, PHD
Entity Type:Organization
Organization Name:AMANDA CASSIL, PHD
Other - Org Name:DR. AMANDA CASSIL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-765-1635
Mailing Address - Street 1:547 S MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3114
Mailing Address - Country:US
Mailing Address - Phone:626-765-1635
Mailing Address - Fax:
Practice Address - Street 1:547 S MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3114
Practice Address - Country:US
Practice Address - Phone:626-765-1635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26549251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health