Provider Demographics
NPI:1609275635
Name:CASSIL, AMANDA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:K
Last Name:CASSIL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E COLORADO BLVD STE 632
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2052
Mailing Address - Country:US
Mailing Address - Phone:626-765-1635
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 632
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2052
Practice Address - Country:US
Practice Address - Phone:626-765-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26549103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical