Provider Demographics
NPI:1053932558
Name:MOTELSON, CASSANDRA C
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:C
Last Name:MOTELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 EAGLE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-6114
Mailing Address - Country:US
Mailing Address - Phone:908-377-5164
Mailing Address - Fax:
Practice Address - Street 1:30 E 76TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2765
Practice Address - Country:US
Practice Address - Phone:212-362-2820
Practice Address - Fax:646-863-7125
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist