Provider Demographics
NPI:1720259377
Name:MARVIN W. KASSED PHD P.A.
Entity Type:Organization
Organization Name:MARVIN W. KASSED PHD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KASSED
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-842-3999
Mailing Address - Street 1:5510 RIVER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3710
Mailing Address - Country:US
Mailing Address - Phone:727-842-3999
Mailing Address - Fax:727-848-0731
Practice Address - Street 1:5510 RIVER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3704
Practice Address - Country:US
Practice Address - Phone:727-842-3999
Practice Address - Fax:727-848-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLMH001948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty