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General NPI Number Information
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NPI Number | 1033722251
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Entity Type | Individual
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Provider Name | LISA MARIE CASSIDY LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/27/2020
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 1315 JAMESTOWN RD STE 203
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-3303
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Country | US
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Telephone | 757-603-4603
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Fax | 757-257-9146
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Provider Business Mailing Address
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Address Line | PO BOX 155
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City | LIGHTFOOT
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State | VA
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Zip | 23090-0155
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Country | US
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Telephone | 732-312-8307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 94694
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904012018
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License Number State | VA
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