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NPI Code Detail

MEDICARE: DR. JEFFREY E CASSISI PH.D.

MEDICARE: DR. JEFFREY E CASSISI PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist#3120NC
2103TC0700XClinical PsychologistPY 3989FL

General Provider Information

NPI Number : 1396899100
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY E CASSISI PH.D.
Provider Business Mailing Address
First Line : 3201 BENTWILLOW DR
Second Line :
City : FUQUAY VARINA
State : NC
Zip : 27526-8686
Country : US
Telephone Number : 919-889-9625
Fax Number : 910-672-1043
Provider Business Practice Location Address
First Line : 1200 MURCHISON RD
Second Line : DEPT OF PSYCHOLOGY, FAYETTEVILLE STATE UNIVERSITY
City : FAYETTEVILLE
State : NC
Zip : 28301-4252
Country : US
Telephone Number : 910-672-1577
Fax Number : 910-672-1043
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 07/08/2007

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