Provider Demographics
NPI:1659955144
Name:DEL ROSARIO, CASSONDRA (MA, MA)
Entity Type:Individual
Prefix:MS
First Name:CASSONDRA
Middle Name:
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:MA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-8633
Mailing Address - Country:US
Mailing Address - Phone:562-381-4316
Mailing Address - Fax:
Practice Address - Street 1:204 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2623
Practice Address - Country:US
Practice Address - Phone:310-396-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2023-07-12
Deactivation Date:2021-12-27
Deactivation Code:
Reactivation Date:2022-11-04
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
CAAPCC10925101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program