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NPI Code Detail

MEDICARE: MS. SHELAGH MARIE CASSIDY LCSW

MEDICARE: MS. SHELAGH MARIE CASSIDY LCSW
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 WorkerKY1401KY
21041C0700XClinical Social WorkerKY1401KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467445056
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHELAGH MARIE CASSIDY LCSW
Provider Business Mailing Address
First Line : 496 SOUTHLAND DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40503-1827
Country : US
Telephone Number : 859-288-2392
Fax Number : 859-721-3918
Provider Business Practice Location Address
First Line : 496 SOUTHLAND DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40503-1827
Country : US
Telephone Number : 859-288-2425
Fax Number : 859-288-7516
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 05/23/2019

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