Healthcare Provider Details

I. General information

NPI: 1255167094
Provider Name (Legal Business Name): CASSIDY LEE JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TOWN CENTER BLVD STE 2
CRESTVIEW HILLS KY
41017-2416
US

IV. Provider business mailing address

1101 BENZ AVE
CINCINNATI OH
45238-4407
US

V. Phone/Fax

Practice location:
  • Phone: 859-360-6120
  • Fax:
Mailing address:
  • Phone: 513-208-6757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2613889
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW00001554
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: