Provider Demographics
NPI:1760724710
Name:CASSIDY, CHRISTINA F (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:F
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7209 SOUTHGATE CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-5331
Mailing Address - Country:US
Mailing Address - Phone:508-733-7193
Mailing Address - Fax:
Practice Address - Street 1:1605 W UNIVERSITY PKWY STE 102
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2732
Practice Address - Country:US
Practice Address - Phone:508-733-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-17
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW166201041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty