Provider Demographics
NPI:1598920233
Name:CASSELL, MARY ANN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:CASSELL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 BACKLICK RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2607
Mailing Address - Country:US
Mailing Address - Phone:703-229-0202
Mailing Address - Fax:703-569-0321
Practice Address - Street 1:6315 BACKLICK RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2607
Practice Address - Country:US
Practice Address - Phone:703-229-0202
Practice Address - Fax:703-569-0321
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-04-2057171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator