Provider Demographics
NPI:1831658376
Name:DRAGONFLY PSYCHOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:DRAGONFLY PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:484-440-9740
Mailing Address - Street 1:2300 COMPUTER RD STE C15
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1735
Mailing Address - Country:US
Mailing Address - Phone:484-440-9740
Mailing Address - Fax:
Practice Address - Street 1:600 N JACKSON ST STE 306
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2530
Practice Address - Country:US
Practice Address - Phone:484-440-9740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty