Provider Demographics
NPI:1891446944
Name:CASSIDY, DAWN MICHELLE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MICHELLE
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FARMINGDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6207
Mailing Address - Country:US
Mailing Address - Phone:631-447-6460
Mailing Address - Fax:
Practice Address - Street 1:3390 ROUTE 112 STE A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1442
Practice Address - Country:US
Practice Address - Phone:631-882-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113650-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker