Provider Demographics
NPI:1265560114
Name:CASSIDY, CYNTHIA (MA, LCPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HUEHL RD
Mailing Address - Street 2:BLDG.8
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2319
Mailing Address - Country:US
Mailing Address - Phone:847-770-6088
Mailing Address - Fax:847-562-0202
Practice Address - Street 1:601 SKOKIE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2851
Practice Address - Country:US
Practice Address - Phone:847-205-1524
Practice Address - Fax:847-562-0202
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL80000627103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical