Provider Demographics
NPI:1326075896
Name:CASSIDY, PATRICK VINCENT (LSW)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:VINCENT
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 PLEASANT VUE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALEXANDRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15670-3148
Mailing Address - Country:US
Mailing Address - Phone:724-668-8960
Mailing Address - Fax:
Practice Address - Street 1:VA PRIMARY CARE CLINIC
Practice Address - Street 2:RTE 30W RR6 BOX211
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-837-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0130571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW013057OtherPA SW LICENSE #