Healthcare Provider Details

I. General information

NPI: 1265529218
Provider Name (Legal Business Name): ZIPORA F MASSIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 BROADWAY
BRONX NY
10471-2701
US

IV. Provider business mailing address

12212 HILLSIDE AVE
RICHMOND HILL NY
11418-1814
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-4424
  • Fax: 718-796-4138
Mailing address:
  • Phone: 718-847-3695
  • Fax: 718-847-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR053981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: