MEDICARE: DR. HEATHER LYLE CASSIDY PSYD

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
1	103TC0700X	Clinical Psychologist	PSY1000359	DC
2	103TC0700X	Clinical Psychologist	04180	MD

General Provider Information

NPI Number	:	1427098961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER LYLE CASSIDY PSYD

Provider Business Mailing Address
First Line	:	1800 BELVEDERE BLVD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4004
Country	:	US
Telephone Number	:	202-251-5197
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 GEORGIA AVE STE 305
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3605
Country	:	US
Telephone Number	:	202-251-5197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	12/30/2022

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