Provider Demographics
NPI:1275740250
Name:DELACOEUR, CASSANDRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:DELACOEUR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1266
Mailing Address - Country:US
Mailing Address - Phone:805-654-8012
Mailing Address - Fax:805-654-8012
Practice Address - Street 1:901 CLIFF DR
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-1266
Practice Address - Country:US
Practice Address - Phone:805-654-8012
Practice Address - Fax:805-654-8012
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15214103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15214Medicare ID - Type Unspecified