Provider Demographics
NPI:1871040402
Name:MOMESSO, HELOISA
Entity Type:Individual
Prefix:
First Name:HELOISA
Middle Name:
Last Name:MOMESSO
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 1:6 GOLDEN HILL ROAD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4655
Mailing Address - Country:US
Mailing Address - Phone:203-313-6658
Mailing Address - Fax:
Practice Address - Street 1:6 GOLDEN HILL RD
Practice Address - Street 2:UNIT 2
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4655
Practice Address - Country:US
Practice Address - Phone:203-313-6658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2019-08-07
Deactivation Date:2018-02-27
Deactivation Code:
Reactivation Date:2019-08-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst