Provider Demographics
NPI:1538530472
Name:CASSELLA, MICHAEL J (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CASSELLA
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 1:747 MAIN ST
Mailing Address - Street 2:SUITE 319
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3302
Mailing Address - Country:US
Mailing Address - Phone:978-393-1925
Mailing Address - Fax:
Practice Address - Street 1:747 MAIN ST
Practice Address - Street 2:SUITE 319
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3302
Practice Address - Country:US
Practice Address - Phone:978-393-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9751103TA0700X, 103TB0200X, 103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy