Provider Demographics
NPI:1033722251
Name:CASSIDY, LISA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:LIGHTFOOT
Mailing Address - State:VA
Mailing Address - Zip Code:23090-0155
Mailing Address - Country:US
Mailing Address - Phone:732-312-8307
Mailing Address - Fax:
Practice Address - Street 1:1315 JAMESTOWN RD STE 203
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3303
Practice Address - Country:US
Practice Address - Phone:757-603-4603
Practice Address - Fax:757-257-9146
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA946941041C0700X
VA09040120181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical