Healthcare Provider Details

I. General information

NPI: 1457384323
Provider Name (Legal Business Name): BETTY JONE MASSEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5189 HOSPITAL RD
MARIPOSA CA
95338-9524
US

IV. Provider business mailing address

4684 MORNING STAR LN
MARIPOSA CA
95338-9361
US

V. Phone/Fax

Practice location:
  • Phone: 209-966-3631
  • Fax: 209-966-8438
Mailing address:
  • Phone: 209-966-7540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS#12379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: