Provider Demographics
NPI:1790791762
Name:CASSIDY, JAMES PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PAUL
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25690 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7100
Mailing Address - Country:US
Mailing Address - Phone:310-375-8789
Mailing Address - Fax:
Practice Address - Street 1:25690 CRENSHAW BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-7100
Practice Address - Country:US
Practice Address - Phone:310-375-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPC 9723103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP-9723OtherSTATE PSYCHOLOGIST LICENS