Provider Demographics
NPI:1982474987
Name:MANDOJANA DUCOT, CRASSANDRA ANASTASIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRASSANDRA
Middle Name:ANASTASIA
Last Name:MANDOJANA DUCOT
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 1:1058 KINGSTOWN RD # 101
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2536
Mailing Address - Country:US
Mailing Address - Phone:401-789-1553
Mailing Address - Fax:401-782-1313
Practice Address - Street 1:1058 KINGSTOWN RD # 101
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-2536
Practice Address - Country:US
Practice Address - Phone:401-789-1553
Practice Address - Fax:401-782-1313
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS02238103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent