Provider Demographics
NPI:1659069144
Name:CARR, CASSANDRA MARIA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MARIA
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 DORCHESTER DR APT K3
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-1437
Mailing Address - Country:US
Mailing Address - Phone:609-630-0369
Mailing Address - Fax:
Practice Address - Street 1:226 DORCHESTER DR APT K3
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08512-1437
Practice Address - Country:US
Practice Address - Phone:609-630-0369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-22-59618103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst