Healthcare Provider Details

I. General information

NPI: 1891977526
Provider Name (Legal Business Name): KAREN FLEMING CASSIDY RN,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506A ALLEN ST
SPRINGFIELD MA
01118-1817
US

IV. Provider business mailing address

1506A ALLEN ST
SPRINGFIELD MA
01118-1817
US

V. Phone/Fax

Practice location:
  • Phone: 413-783-5500
  • Fax: 413-782-7612
Mailing address:
  • Phone: 413-783-5500
  • Fax: 413-782-7612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number165676
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: