Provider Demographics
NPI:1336796309
Name:MOSS, CASSANDRA L (PHD)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:L
Last Name:MOSS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06141-0422
Mailing Address - Country:US
Mailing Address - Phone:860-299-6292
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 422
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06141-0422
Practice Address - Country:US
Practice Address - Phone:860-299-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2025-03-20
Deactivation Date:2024-12-23
Deactivation Code:
Reactivation Date:2025-03-14
Provider Licenses
StateLicense IDTaxonomies
CT1787103K00000X
CT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst