MEDICARE: DYLAN MARTIN CASSIDY BCBA, LBA

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	103K00000X	Behavior Analyst	12687534	TX

General Provider Information

NPI Number	:	1578417317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN MARTIN CASSIDY BCBA, LBA

Provider Business Mailing Address
First Line	:	5018 SAN JACINTO ST APT 106
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-7716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5018 SAN JACINTO ST APT 106
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-7716
Country	:	US
Telephone Number	:	214-504-4831
Fax Number	:

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

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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