=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093302804
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASSIDY DEAR L.M.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2020
-----------------------------------------------------
Last Update Date | 12/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7540 MEMORIAL PKWY SW STE W
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35802-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-824-9171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 685 PROVIDENCE MAIN ST NW APT 78
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35806-2646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-218-7229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 5226G
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------