Healthcare Provider Details

I. General information

NPI: 1215957048
Provider Name (Legal Business Name): SHARON R MASSOTH M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HAZARD AVE UNIT M2
ENFIELD CT
06082-3890
US

IV. Provider business mailing address

148 HILLWINDS N
BRATTLEBORO VT
05301-9076
US

V. Phone/Fax

Practice location:
  • Phone: 203-980-3993
  • Fax:
Mailing address:
  • Phone: 203-980-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002059
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: