Provider Demographics
NPI:1528059581
Name:CASSIDY, GEORGIA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:A
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7929 BRESSINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3158
Mailing Address - Country:US
Mailing Address - Phone:703-805-0118
Mailing Address - Fax:703-805-0967
Practice Address - Street 1:DEWITT ARMY HOSPITAL
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:703-805-0118
Practice Address - Fax:703-805-0967
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040026901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical