Provider Demographics
NPI:1588399125
Name:SUMMERS, CASSIANNA MIRANDA (AMFT)
Entity type:Individual
Prefix:MRS
First Name:CASSIANNA
Middle Name:MIRANDA
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8246 KINLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3739
Mailing Address - Country:US
Mailing Address - Phone:909-200-6726
Mailing Address - Fax:
Practice Address - Street 1:1 N INDIAN HILL BLVD STE 208
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4769
Practice Address - Country:US
Practice Address - Phone:909-675-7185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health