Provider Demographics
NPI:1164014726
Name:WILSON-CASSIDY, MELISSA (CSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WILSON-CASSIDY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 VICTORIA WAY
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9195
Mailing Address - Country:US
Mailing Address - Phone:910-584-0678
Mailing Address - Fax:
Practice Address - Street 1:1 PHYSICIANS PARK
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4192
Practice Address - Country:US
Practice Address - Phone:910-584-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2538711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical