MEDICARE: M.J.A. BEHAVIORAL HEALTH AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1215663018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.J.A. BEHAVIORAL HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	9 KARLAK ST
Second Line	:
City	:	SEYMOUR
State	:	CT
Zip	:	06483-2617
Country	:	US
Telephone Number	:	914-843-9406
Fax Number	:	475-314-3070

Provider Business Practice Location Address
First Line	:	9 KARLAK ST
Second Line	:
City	:	SEYMOUR
State	:	CT
Zip	:	06483-2617
Country	:	US
Telephone Number	:	914-843-9406
Fax Number	:	475-314-3070

Authorized Official
Title or Position	:	OWNER
Name	:	CASSANDRA DESSUREAU-O'HARA
Credential	:	LPC
Telephone Number	:	914-843-9406

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	12/22/2025

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