Provider Demographics
NPI:1891280616
Name:BISHOP, CASSIDY MARIE (LSW)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:MARIE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:MARIE
Other - Last Name:KONITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1129 MIAMISBURG CENTERVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-4052
Mailing Address - Country:US
Mailing Address - Phone:937-866-4021
Mailing Address - Fax:937-866-4058
Practice Address - Street 1:1129 MIAMISBURG CENTERVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-4052
Practice Address - Country:US
Practice Address - Phone:937-866-4021
Practice Address - Fax:937-866-4058
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802593171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator