Healthcare Provider Details

I. General information

NPI: 1396239042
Provider Name (Legal Business Name): CASSANDRA DOUGHTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2018
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 OAKLAND RD UNIT 402
SOUTH WINDSOR CT
06074-5567
US

IV. Provider business mailing address

175 OAKLAND RD UNIT 402
SOUTH WINDSOR CT
06074-5567
US

V. Phone/Fax

Practice location:
  • Phone: 860-336-9740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: