Provider Demographics
NPI:1700901774
Name:TASSONE, MARY ANN
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:TASSONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5583 MICHAEL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-3844
Mailing Address - Country:US
Mailing Address - Phone:619-733-2374
Mailing Address - Fax:619-741-2682
Practice Address - Street 1:6244 EL CAJON BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115
Practice Address - Country:US
Practice Address - Phone:619-287-8225
Practice Address - Fax:619-287-4146
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1858101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)