Provider Demographics
NPI:1578223848
Name:CASSERLY, JOANNE EILEEN
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:EILEEN
Last Name:CASSERLY
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:PO BOX 40494
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91114-7494
Mailing Address - Country:US
Mailing Address - Phone:323-528-9856
Mailing Address - Fax:
Practice Address - Street 1:817 E RIO GRANDE ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-5044
Practice Address - Country:US
Practice Address - Phone:323-528-9856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW20601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health