Healthcare Provider Details

I. General information

NPI: 1467771725
Provider Name (Legal Business Name): JESSICA MASSULI CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W MARKET ST
GEORGETOWN DE
19947-2321
US

IV. Provider business mailing address

814 W BIRDIE LN
MAGNOLIA DE
19962-3106
US

V. Phone/Fax

Practice location:
  • Phone: 302-778-9222
  • Fax:
Mailing address:
  • Phone: 443-466-9129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number114964
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberQ3-0010544
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number948
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: