Provider Demographics
NPI:1851144075
Name:CASSIDY, TERRENCE (RN)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-5219
Mailing Address - Country:US
Mailing Address - Phone:855-687-2410
Mailing Address - Fax:
Practice Address - Street 1:2200 PROVIDENCE AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-5219
Practice Address - Country:US
Practice Address - Phone:855-687-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN610337163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)