Provider Demographics
NPI:1922187335
Name:CASSIDY, PAUL F JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:F
Last Name:CASSIDY
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 OX BOW LN
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2511
Mailing Address - Country:US
Mailing Address - Phone:781-718-6465
Mailing Address - Fax:
Practice Address - Street 1:4364 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-4614
Practice Address - Country:US
Practice Address - Phone:508-998-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10166131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05107Medicare UPIN
MAPO5107Medicare ID - Type Unspecified