Provider Demographics
NPI:1316319544
Name:KASSON, MICHELE
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:KASSON
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 1:10 WATERSIDE PLZ APT 15J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2604
Mailing Address - Country:US
Mailing Address - Phone:917-331-5883
Mailing Address - Fax:
Practice Address - Street 1:595 GERARD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5239
Practice Address - Country:US
Practice Address - Phone:718-742-6312
Practice Address - Fax:718-742-6016
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011558-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical