Provider Demographics
NPI:1447760483
Name:COSME, CASSAUNDRA
Entity Type:Individual
Prefix:
First Name:CASSAUNDRA
Middle Name:
Last Name:COSME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 W SIERRA MADRE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2714
Mailing Address - Country:US
Mailing Address - Phone:626-355-5160
Mailing Address - Fax:626-355-5173
Practice Address - Street 1:41765 12TH ST W STE B
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1422
Practice Address - Country:US
Practice Address - Phone:661-723-8600
Practice Address - Fax:661-726-8660
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst