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General NPI Number Information
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NPI Number | 1215663018
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Entity Type | Organization
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Legal Business Name | M.J.A. BEHAVIORAL HEALTH AND WELLNESS
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 9 KARLAK ST
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City | SEYMOUR
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State | CT
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Zip | 06483-2617
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Country | US
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Telephone | 914-843-9406
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Fax | 475-314-3070
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Provider Business Mailing Address
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Address Line | 9 KARLAK ST
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City | SEYMOUR
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State | CT
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Zip | 06483-2617
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Country | US
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Telephone | 914-843-9406
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Fax | 475-314-3070
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Authorized Official
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Title or Position | OWNER
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Name | CASSANDRA DESSUREAU-O'HARA
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Credential | LPC
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Telephone | 914-843-9406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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