Provider Demographics
NPI:1881025468
Name:CASSIO, ABRAHAM
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:CASSIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-1224
Mailing Address - Country:US
Mailing Address - Phone:760-886-1065
Mailing Address - Fax:
Practice Address - Street 1:535 CESAR CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2103
Practice Address - Country:US
Practice Address - Phone:760-357-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor