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General NPI Number Information
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NPI Number | 1265560114
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Entity Type | Individual
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Provider Name | CYNTHIA CASSIDY M.A., LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 601 SKOKIE BLVD SUITE 500
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City | NORTHBROOK
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State | IL
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Zip | 60062-2851
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Country | US
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Telephone | 847-205-1524
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Fax | 847-562-0202
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Provider Business Mailing Address
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Address Line | 425 HUEHL RD BLDG.8
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City | NORTHBROOK
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State | IL
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Zip | 60062-2319
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Country | US
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Telephone | 847-770-6088
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Fax | 847-562-0202
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 80000627
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License Number State | IL
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