Provider Demographics
NPI:1154484988
Name:CASSIDY, DONNA M (MSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 BLACKSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5813
Mailing Address - Country:US
Mailing Address - Phone:401-273-7112
Mailing Address - Fax:401-274-8070
Practice Address - Street 1:189 GOVERNOR ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3124
Practice Address - Country:US
Practice Address - Phone:401-273-2447
Practice Address - Fax:401-274-8070
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW005841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3731-4OtherBLUE CROSS BLUE SHIELD
RI18051-361OtherUNITED HEALTHCARE