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General NPI Number Information
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NPI Number | 1568508513
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Entity Type | Individual
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Provider Name | MARY STEWART CASSADY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 11111 HALL RD STE 201
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City | UTICA
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State | MI
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Zip | 48317-5711
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Country | US
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Telephone | 586-254-7383
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Fax | 586-254-7383
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Provider Business Mailing Address
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Address Line | 36873 MORAVIAN DR
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City | CLINTON TWP
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State | MI
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Zip | 48035-1211
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Country | US
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Telephone | 586-214-8425
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 6301012228
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301012228
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License Number State | MI
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