Provider Demographics
NPI:1578767257
Name:CASSEL, MARY ELIZABETH (MFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:CASSEL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:CASSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:207 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2643
Mailing Address - Country:US
Mailing Address - Phone:415-721-7116
Mailing Address - Fax:415-459-0362
Practice Address - Street 1:5028 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2814
Practice Address - Country:US
Practice Address - Phone:415-289-2241
Practice Address - Fax:415-459-0362
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist