Provider Demographics
NPI:1336805381
Name:KEIM, CASSIDY (LCPC)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:KEIM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:LOVALLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:10606 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4079
Mailing Address - Country:US
Mailing Address - Phone:240-810-3790
Mailing Address - Fax:
Practice Address - Street 1:10606 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4079
Practice Address - Country:US
Practice Address - Phone:240-810-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11781101YM0800X
MDLC13898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health