Provider Demographics
NPI:1801651252
Name:CASSADY, AMBER MARAY
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARAY
Last Name:CASSADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 DON BISHOP RD UNIT 9-4
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-8410
Mailing Address - Country:US
Mailing Address - Phone:520-732-0793
Mailing Address - Fax:
Practice Address - Street 1:108 DON BISHOP RD UNIT 9-4
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-8410
Practice Address - Country:US
Practice Address - Phone:520-732-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician