Provider Demographics
NPI:1245633700
Name:CASSIDY, KERRY ANNE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:ANNE
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:ANNE
Other - Last Name:O'MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:47 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-7830
Mailing Address - Country:US
Mailing Address - Phone:917-848-8076
Mailing Address - Fax:
Practice Address - Street 1:47 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-7830
Practice Address - Country:US
Practice Address - Phone:917-848-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst