Provider Demographics
NPI:1770511347
Name:CASSIDY, DONALD (PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19900 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BRINKLOW
Mailing Address - State:MD
Mailing Address - Zip Code:20862-9744
Mailing Address - Country:US
Mailing Address - Phone:301-493-4200
Mailing Address - Fax:301-493-6209
Practice Address - Street 1:6040 SOUTHPORT DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1848
Practice Address - Country:US
Practice Address - Phone:301-493-4200
Practice Address - Fax:301-493-6209
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52473002OtherCAREFIRST NON PAR #
MD52473002OtherCAREFIRST NON PAR #