MEDICARE: MS. ELISABETH E MASSARO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I05491	NM

General Provider Information

NPI Number	:	1902821911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELISABETH E MASSARO LCSW

Provider Business Mailing Address
First Line	:	PO BOX 6338
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87502-6338
Country	:	US
Telephone Number	:	505-438-2612
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 ZOZOBRA LN
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-6100
Country	:	US
Telephone Number	:	505-577-5758
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/21/2020

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