Provider Demographics
NPI:1326655325
Name:NASCIMENTO, CASSIO DO
Entity Type:Individual
Prefix:
First Name:CASSIO
Middle Name:DO
Last Name:NASCIMENTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SUDAN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2087
Mailing Address - Country:US
Mailing Address - Phone:617-818-4001
Mailing Address - Fax:
Practice Address - Street 1:40 SUDAN ST APT 3
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-2087
Practice Address - Country:US
Practice Address - Phone:617-818-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist