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NPI Code Detail

MEDICARE: MRS. CHERYL RICELYN CASSIDY LMSW

MEDICARE: MRS. CHERYL RICELYN CASSIDY LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker053623-1NY

General Provider Information

NPI Number : 1114160801
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHERYL RICELYN CASSIDY LMSW
Provider Business Mailing Address
First Line : 2795 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-5866
Country : US
Telephone Number : 718-761-9800
Fax Number : 718-370-1142
Provider Business Practice Location Address
First Line : 2795 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-5866
Country : US
Telephone Number : 718-761-9800
Fax Number : 718-761-1643
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2009
Last Update Date : 03/26/2015

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Directions to “ MRS. CHERYL RICELYN CASSIDY LMSW” Practice Location

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