Provider Demographics
NPI:1356797989
Name:CASSIDY, LACY ANNE (BCBA)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:ANNE
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 EDMONDSON PIKE STE 105
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6852
Mailing Address - Country:US
Mailing Address - Phone:615-564-4984
Mailing Address - Fax:
Practice Address - Street 1:5511 EDMONDSON PIKE STE 105
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6852
Practice Address - Country:US
Practice Address - Phone:615-564-4984
Practice Address - Fax:833-645-0881
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TNLBA678103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst