Healthcare Provider Details

I. General information

NPI: 1497834428
Provider Name (Legal Business Name): CIRO ANTHONY MASSA LCSW LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MAIN ST
DANIELSON CT
06239-2816
US

IV. Provider business mailing address

245 MAIN ST
DANIELSON CT
06239-2816
US

V. Phone/Fax

Practice location:
  • Phone: 888-316-5221
  • Fax: 866-203-2138
Mailing address:
  • Phone: 888-316-5221
  • Fax: 866-203-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000204
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004254
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier008004012
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: