Healthcare Provider Details

I. General information

NPI: 1992968119
Provider Name (Legal Business Name): JOANN MASSEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E DE SOTO ST
PENSACOLA FL
32501-3337
US

IV. Provider business mailing address

1221 E DE SOTO ST
PENSACOLA FL
32501-3337
US

V. Phone/Fax

Practice location:
  • Phone: 850-439-2100
  • Fax: 850-439-2122
Mailing address:
  • Phone: 850-439-2100
  • Fax: 850-439-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY5216
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: