Basic Information
| Provider Information | |||||||||
| NPI: | 1427098961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASSIDY | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | LYLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 IRVING ST NW | ||||||||
| Address2: | PSYCHOLOGY DEPARTMENT | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200102921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028771765 | ||||||||
| FaxNumber: | 2022915366 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 IRVING ST NW | ||||||||
| Address2: | PSYCHOLOGY DEPARTMENT | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200102921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028771765 | ||||||||
| FaxNumber: | 2022915366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 04180 | MD | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | PSY1000359 | DC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.