MEDICARE: MRS. CASSANDRA JOY DESSUREAU-O'HARA

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	101YP2500X	Professional Counselor		CT

General Provider Information

NPI Number	:	1801498910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASSANDRA JOY DESSUREAU-O'HARA

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	:

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	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	11/13/2020

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