Provider Demographics
NPI:1285884510
Name:CASSIDY, NOEL REGINA (PHARMD, LCSW)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:REGINA
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:PHARMD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5472 E 140TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8914
Mailing Address - Country:US
Mailing Address - Phone:303-847-2861
Mailing Address - Fax:
Practice Address - Street 1:215 S PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3131
Practice Address - Country:US
Practice Address - Phone:719-327-6565
Practice Address - Fax:719-327-6566
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10771041C0700X
CO19881183500000X
CA70436183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical