Organization
LISA M. CASSIDY, PSYCHOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M CASSIDY PH.D. (LICENSED PSYCHOLOGIST)
(631) 748-4659
Entity
Organization
Contact information
Practice address
4250 VETS HWY, SUITE 215, HOLBROOK, NY 11741-4000
(631) 748-4659
Mailing address
4250 VETS HWY, SUITE 215, HOLBROOK, NY 11741-4000
(631) 748-4659
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
011578
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396287835
PRIVATE NPI NUMBER
NY
Enumeration date
11/28/2016
Last updated
11/28/2016
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