Healthcare Provider Details

I. General information

NPI: 1386092096
Provider Name (Legal Business Name): EMILY MASOTTI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LANG BLVD STE 1
GRAND ISLAND NY
14072-1601
US

IV. Provider business mailing address

101 LANG BLVD STE 1
GRAND ISLAND NY
14072-1601
US

V. Phone/Fax

Practice location:
  • Phone: 716-219-8494
  • Fax:
Mailing address:
  • Phone: 716-219-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number093394
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number09428001
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094280
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: