Provider Demographics
NPI:1184916231
Name:SACASA, MARIO ALBERTO
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ALBERTO
Last Name:SACASA
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 1:4833 CONTI ST STE 206
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-4368
Mailing Address - Country:US
Mailing Address - Phone:504-264-3905
Mailing Address - Fax:
Practice Address - Street 1:4833 CONTI ST STE 206
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-4368
Practice Address - Country:US
Practice Address - Phone:504-264-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2423106H00000X
LAMFT1109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist