Provider Demographics
NPI:1700138559
Name:SASSON, JOE ISAAC (LCSW)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:ISAAC
Last Name:SASSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 7TH AVE
Mailing Address - Street 2:3
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3215
Mailing Address - Country:US
Mailing Address - Phone:619-887-9324
Mailing Address - Fax:
Practice Address - Street 1:2816 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-1401
Practice Address - Country:US
Practice Address - Phone:619-887-9324
Practice Address - Fax:205-386-9610
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61989101YM0800X
NMX-077621041C0700X, 1041S0200X
CA751211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool