Provider Demographics
NPI:1669619664
Name:CASSIDY, ROBERT R (LICSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:MR
Other - First Name:ROBERT R
Other - Middle Name:
Other - Last Name:DRAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-1759
Mailing Address - Country:US
Mailing Address - Phone:978-287-3524
Mailing Address - Fax:978-287-3539
Practice Address - Street 1:36 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-1759
Practice Address - Country:US
Practice Address - Phone:978-287-3524
Practice Address - Fax:978-287-3539
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1032541101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional