Provider Demographics
NPI:1801498910
Name:DESSUREAU-O'HARA, CASSANDRA JOY
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:JOY
Last Name:DESSUREAU-O'HARA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:JOY
Other - Last Name:O'HARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 KARLAK ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2617
Mailing Address - Country:US
Mailing Address - Phone:914-843-9406
Mailing Address - Fax:
Practice Address - Street 1:9 KARLAK ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2617
Practice Address - Country:US
Practice Address - Phone:914-843-9406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional