Healthcare Provider Details

I. General information

NPI: 1104753409
Provider Name (Legal Business Name): KATIE ANN CASSIDY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CREST HAVEN RD
CAPE MAY COURT HOUSE NJ
08210-1652
US

IV. Provider business mailing address

51 BREAKWATER TER
CAPE MAY NJ
08204-3763
US

V. Phone/Fax

Practice location:
  • Phone: 610-202-0263
  • Fax:
Mailing address:
  • Phone: 610-202-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SL07441800
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: