1679696777 NPI number — CLINCAL & FORENSIC PSYCHOLOGY, INC., P.S.

Table of content: DR. DONALD WAYNE CASSIDY JR. D.M.D. (NPI 1114948536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679696777 NPI number — CLINCAL & FORENSIC PSYCHOLOGY, INC., P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINCAL & FORENSIC PSYCHOLOGY, INC., P.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679696777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3815 100TH ST SW
Provider Second Line Business Mailing Address:
STE 2B
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98499-4401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-984-7686
Provider Business Mailing Address Fax Number:
253-984-7862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3815 100TH ST SW
Provider Second Line Business Practice Location Address:
STE 2B
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-984-7686
Provider Business Practice Location Address Fax Number:
253-984-7862
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITEHILL
Authorized Official First Name:
MARK
Authorized Official Middle Name:
BENNETT
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
253-984-7686

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY00001200 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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