Provider Demographics
NPI:1184456428
Name:NELSON, CASSIDY ROSE (LCAT)
Entity type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:ROSE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4831
Mailing Address - Country:US
Mailing Address - Phone:516-306-5000
Mailing Address - Fax:
Practice Address - Street 1:535 BROADHOLLOW RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3713
Practice Address - Country:US
Practice Address - Phone:516-306-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002934101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist