Active NPI
Nicole Cassidy, PSYD
- Clinical Psychologist
- Saint Louis, MO
National Provider Identifier
1689981334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2015032100
- Practice address
- 1 Brookings Dr
Saint Louis, MO 63130-4862 - Phone
- (314) 935-6666
- Fax
- (314) 935-8515
- NPI assigned
- Sep 1, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2015032100 | MO | Primary |
Addresses
Primary practice location
1 Brookings Dr
Saint Louis, MO 63130-4862
Mailing address
1201 Ricker Rd
PO Box 1250
Salem, IL 62881-4263
Phone (314) 935-6666
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015032100 | MO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446422400000",
"number": "1689981334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 RICKER RD",
"address_2": "PO BOX 1250",
"city": "SALEM",
"state": "IL",
"postal_code": "628814263",
"telephone_number": "314-935-6666",
"fax_number": "314-935-8515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BROOKINGS DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631304862",
"telephone_number": "314-935-6666",
"fax_number": "314-935-8515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASSIDY",
"first_name": "NICOLE",
"name_prefix": "Mrs.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-01",
"last_updated": "2015-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "2015032100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.