Provider Demographics
NPI:1730500224
Name:CASSIDY, KEVIN (CADC-II)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SUNRISE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4553
Mailing Address - Country:US
Mailing Address - Phone:916-782-3737
Mailing Address - Fax:916-787-3739
Practice Address - Street 1:730 SUNRISE AVE
Practice Address - Street 2:250
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4567
Practice Address - Country:US
Practice Address - Phone:916-782-3737
Practice Address - Fax:916-787-4359
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA03740315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)