Provider Demographics
NPI:1740415413
Name:COSSA, MARIO M (MA, RDT/MT, TEP)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:M
Last Name:COSSA
Suffix:
Gender:M
Credentials:MA, RDT/MT, TEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 TAMALPAIS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1849
Mailing Address - Country:US
Mailing Address - Phone:510-234-0827
Mailing Address - Fax:
Practice Address - Street 1:2255 TAMALPAIS AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1849
Practice Address - Country:US
Practice Address - Phone:510-234-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor