Provider Demographics
NPI:1215663018
Name:M.J.A. BEHAVIORAL HEALTH AND WELLNESS
Entity type:Organization
Organization Name:M.J.A. BEHAVIORAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESSUREAU-O'HARA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:914-843-9406
Mailing Address - Street 1:9 KARLAK ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2617
Mailing Address - Country:US
Mailing Address - Phone:914-843-9406
Mailing Address - Fax:
Practice Address - Street 1:9 KARLAK ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2617
Practice Address - Country:US
Practice Address - Phone:914-843-9406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty