Individual provider Active NPI

Paul Damien Cassidy, LCSW

  • Clinical Social Worker
  • College Station, TX
National Provider Identifier
1487891941
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW 6576 Issued in FL
Practice address
1651 Rock Prairie Rd Ste 101
College Station, TX 77845-8652
Phone
(850) 723-7703
Fax
(877) 822-7339
NPI assigned
Jan 20, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW 6576 FL Primary

Addresses

Primary practice location

1651 Rock Prairie Rd Ste 101
College Station, TX 77845-8652

Mailing address

40 Shuman Blvd Ste 262
Naperville, IL 60563-8480
Phone (850) 723-7703

Other practice location 1

17347 Village Green Dr
Jersey Village, TX 77040-1159
Phone (281) 668-3510

Other practice location 2

635 Rayford Rd Ste E
Spring, TX 77386-2797
Phone (832) 823-2640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW 6576FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Access Recovery Solutions Current Accepting new patients
Access Recovery Solutions, LLC Clinical CurrentSince Apr 21, 2011 Accepting new patients
Therapeutic Outcomes, LLC Clinical Past Accepting new patients
Gulf Coast Addiction Medicine Past Accepting new patients

Locations

277 Forest Park Cir
Panama City, FL 32405
Phone (850) 522-1516

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1487891941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 SHUMAN BLVD STE 262",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638480",
            "telephone_number": "850-723-7703",
            "fax_number": "877-822-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 ROCK PRAIRIE RD STE 101",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458652",
            "telephone_number": "850-723-7703",
            "fax_number": "877-822-7339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17347 Village Green Dr",
            "address_purpose": "LOCATION",
            "city": "Jersey Village",
            "state": "TX",
            "postal_code": "770401159",
            "country_code": "US",
            "telephone_number": "281-668-3510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "635 Rayford Rd Ste E",
            "address_purpose": "LOCATION",
            "city": "Spring",
            "state": "TX",
            "postal_code": "773862797",
            "country_code": "US",
            "telephone_number": "832-823-2640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CASSIDY",
        "first_name": "PAUL",
        "middle_name": "DAMIEN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-01-20",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW 6576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in College Station, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.