Individual
CLARA CASSIDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50 DONALD BEAN DR, STE B, SOUTH PORTLAND, ME 04106
(207) 274-2528
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XVH0000270784
ANTHEM
ME
Enumeration date
09/26/2019
Last updated
09/26/2019
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