Provider Demographics
NPI:1861054652
Name:MOUNTAIN, CASSANDRA (BCBA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MOUNTAIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:GENDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 TUPELO RD
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1625
Mailing Address - Country:US
Mailing Address - Phone:617-291-4897
Mailing Address - Fax:
Practice Address - Street 1:20 TREMONT ST
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-5310
Practice Address - Country:US
Practice Address - Phone:781-987-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-14-16609103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst