{
"Npi": {
"NPI": "1760357099",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WATERBURY",
"FirstName": "CASSANDRA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "APRN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "33 PLAINS RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HADDAM",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06438-1232",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-975-7277",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "21 MONTAUK AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW LONDON",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06320-4906",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-975-7277",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/07/2025",
"LastUpdateDate": "01/22/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "12.015435",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}