Individual
CASSIDY FAMULARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPCC, LADC
Contact information
Practice address
900 LONG LAKE RD STE 160, NEW BRIGHTON, MN 55112-6414
(612) 706-9630
Mailing address
7627 10TH AVE S, MINNEAPOLIS, MN 55423-4572
(952) 217-3291
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304573
MN
101YP2500X
Professional Counselor
Primary
2527
MN
Other
Enumeration date
10/01/2020
Last updated
03/05/2025
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