Provider Demographics
NPI:1407107329
Name:CASSIDY, PATRICIA CRISTINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:CRISTINA
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WOODLAND AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3138
Mailing Address - Country:US
Mailing Address - Phone:917-744-0015
Mailing Address - Fax:
Practice Address - Street 1:7 WOODLAND AVE STE 4
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3138
Practice Address - Country:US
Practice Address - Phone:917-744-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013053-1103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical