Provider Demographics
NPI:1245931625
Name:MARTINEAU OLD, CASSANDRA
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MARTINEAU OLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:IRVING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03244-5319
Mailing Address - Country:US
Mailing Address - Phone:603-748-9099
Mailing Address - Fax:
Practice Address - Street 1:213 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:NH
Practice Address - Zip Code:03244-5319
Practice Address - Country:US
Practice Address - Phone:603-748-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician