Healthcare Provider Details

I. General information

NPI: 1730794264
Provider Name (Legal Business Name): CASSIDY MYERS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSIDY WALSH

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 JOHNSON ST APT 6A
BROOKLYN NY
11201-3034
US

IV. Provider business mailing address

176 JOHNSON ST APT 6A
BROOKLYN NY
11201-3034
US

V. Phone/Fax

Practice location:
  • Phone: 817-714-8595
  • Fax:
Mailing address:
  • Phone: 817-714-8595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number002924
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: