MEDICARE: MR. PAUL DAMIEN 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
1	1041C0700X	Clinical Social Worker	SW 6576	FL

General Provider Information

NPI Number	:	1487891941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL DAMIEN CASSIDY LCSW

Provider Business Mailing Address
First Line	:	40 SHUMAN BLVD STE 262
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8480
Country	:	US
Telephone Number	:	850-723-7703
Fax Number	:	877-822-7339

Provider Business Practice Location Address
First Line	:	1651 ROCK PRAIRIE RD STE 101
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8652
Country	:	US
Telephone Number	:	850-723-7703
Fax Number	:	877-822-7339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	08/18/2021

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