Provider Demographics
NPI:1760945190
Name:CASSIDY, MELINDA MEGHAN
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MEGHAN
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 OLNEY SANDY SPRING RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-1013
Mailing Address - Country:US
Mailing Address - Phone:240-426-2083
Mailing Address - Fax:
Practice Address - Street 1:2923 OLNEY SANDY SPRING RD STE C
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1582
Practice Address - Country:US
Practice Address - Phone:240-426-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD214311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical