Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003071267 |
---|---|
Provider Name | Paul Cassidy |
First Address | Berlin, NJ 08009-9201 |
Second Address | Berlin, NJ 08009-9201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2008 |
Last Update Date | 26/07/2008 |