Provider Demographics
NPI:1568508513
Name:CASSADY, MARY STEWART (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:STEWART
Last Name:CASSADY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:STEWART
Other - Last Name:SPILMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36873 MORAVIAN DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1211
Mailing Address - Country:US
Mailing Address - Phone:586-214-8425
Mailing Address - Fax:
Practice Address - Street 1:11111 HALL RD
Practice Address - Street 2:STE 201
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5711
Practice Address - Country:US
Practice Address - Phone:586-254-7383
Practice Address - Fax:586-254-7383
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012228103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent