Provider Demographics
NPI:1881726867
Name:CASSUTT, TIMOTHY JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:CASSUTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S EUCLID AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2446
Mailing Address - Country:US
Mailing Address - Phone:626-351-0888
Mailing Address - Fax:626-351-0888
Practice Address - Street 1:1260 TROPICAL AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1619
Practice Address - Country:US
Practice Address - Phone:626-351-0888
Practice Address - Fax:626-351-0888
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15108103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical