Healthcare Provider Details

I. General information

NPI: 1740496447
Provider Name (Legal Business Name): MARY CASSADY PH.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 HALL RD SUITE 201
UTICA MI
48317-5711
US

IV. Provider business mailing address

11111 HALL RD SUITE 201
UTICA MI
48317-5711
US

V. Phone/Fax

Practice location:
  • Phone: 586-254-7383
  • Fax:
Mailing address:
  • Phone: 586-254-7383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301012228
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301012228
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301012228
License Number StateMI

VIII. Authorized Official

Name: DR. MARY CASSADY
Title or Position: OWNER
Credential: PH.D.
Phone: 586-254-7383