MEDICARE: CASSIDY CARIN OHIA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1922659077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIDY CARIN OHIA

Provider Business Mailing Address
First Line	:	91-1841 FORT WEAVER RD
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-1909
Country	:	US
Telephone Number	:	808-542-3879
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-1121 KEAUNUI DR STE 108
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6365
Country	:	US
Telephone Number	:	808-542-3879
Fax Number	:

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

Provider Enumeration Date	:	09/20/2019
Last Update Date	:	05/27/2022

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Directions to “ CASSIDY CARIN OHIA ” Practice Location

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