Healthcare Provider Details

I. General information

NPI: 1467445056
Provider Name (Legal Business Name): SHELAGH MARIE CASSIDY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 SOUTHLAND DR
LEXINGTON KY
40503-1827
US

IV. Provider business mailing address

496 SOUTHLAND DR
LEXINGTON KY
40503-1827
US

V. Phone/Fax

Practice location:
  • Phone: 859-288-2425
  • Fax: 859-288-7516
Mailing address:
  • Phone: 859-288-2392
  • Fax: 859-721-3918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberKY1401
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberKY1401
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: