Doctor Name: | MARTHAJANE S CASSIDEY |
NPI Number: | 1497845119 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS |
License Number: | |
Business Practice Address: | 57 Industrial Park Road Lucedale, MS - 39452 |
Business Phone Number: | 6019474274 |
Business Fax Number: | 6019474275 |
Mailing Address: | 3407 Shamrock Court, GAUTIER |
State: | MS |
Postal Code: | 39553 |
Phone Number: | 2284970690 |
Fax Number: | 2284971363 |
NPI Enumeration Date: | 10/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |