| Jennie Cassidy Psychologist Llc | |
|
1511 9th Ave Ste C Conway SC 29526-4126 | |
| (843) 685-0264 | |
| (843) 748-0448 |
| Full Name | Jennie Cassidy Psychologist Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1511 9th Ave Ste C, Conway, South Carolina |
| Authorized Official Name and Position | Jennie May Cassidy (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 8436850264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennie Cassidy Psychologist Llc 1192 Jumper Trail Cir Myrtle Beach SC 29588-5289 Ph: (843) 685-0264 | Jennie Cassidy Psychologist Llc 1511 9th Ave Ste C Conway SC 29526-4126 Ph: (843) 685-0264 |
| NPI Number | 1447884705 |
|---|---|
| Provider Enumeration Date | 02/26/2020 |
| Last Update Date | 02/26/2020 |
| Certification Date | 02/26/2020 |
| Medicare PECOS PAC ID | 1254760846 |
|---|---|
| Medicare Enrollment ID | O20200402001265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447884705 | NPI | - | NPPES |
| PS0674 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jennie May Cassidy |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1184752495 PECOS PAC ID: 2163851759 Enrollment ID: I20200402001370 |
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