Basic Information
| Provider Information | |||||||||
| NPI: | 1912533381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRENCH | ||||||||
| FirstName: | CASSIDY | ||||||||
| MiddleName: | GRACE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6301 INDUCON DR E | ||||||||
| Address2: | |||||||||
| City: | SANBORN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141329098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167312030 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6301 INDUCON DR E | ||||||||
| Address2: | |||||||||
| City: | SANBORN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141329098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167312030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2020 | ||||||||
| LastUpdateDate: | 03/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.