Provider Demographics
NPI:1134446453
Name:CASSIDY, REAGAN MICHELLE (MED, BCBA)
Entity type:Individual
Prefix:MISS
First Name:REAGAN
Middle Name:MICHELLE
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SOUTHWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1224
Mailing Address - Country:US
Mailing Address - Phone:508-527-6884
Mailing Address - Fax:
Practice Address - Street 1:83 PINE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3646
Practice Address - Country:US
Practice Address - Phone:978-717-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst