Provider Demographics
NPI:1043639594
Name:CASSIDY, VICTORIA LYNNE (LIMHP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNNE
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4318 FORT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-1849
Mailing Address - Country:US
Mailing Address - Phone:402-552-4707
Mailing Address - Fax:
Practice Address - Street 1:4318 FORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111
Practice Address - Country:US
Practice Address - Phone:402-552-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2124101Y00000X, 101YP2500X
MO7366101YA0400X
MO2014001621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)