Provider Demographics
NPI:1164404695
Name:CASSIDY, ALEXANDRA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:L
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:L
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 N US HIGHWAY 89
Mailing Address - Street 2:NORTHERN ARIZONA VA HCS (NAVAHCS)
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86313
Mailing Address - Country:US
Mailing Address - Phone:928-445-4860
Mailing Address - Fax:928-776-8484
Practice Address - Street 1:500 N US HIGHWAY 89
Practice Address - Street 2:NORTHERN ARIZONA VA HCS (NAVAHCS)
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:928-776-8484
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW106211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical