Healthcare Provider Details

I. General information

NPI: 1235187196
Provider Name (Legal Business Name): JOHN D. MASSELLA ED.D, LPC, NCC, CCS,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 WASHINGTON RD SUITE 201
MC MURRAY PA
15317-2533
US

IV. Provider business mailing address

115 CASTLEBROOKE DR
VENETIA PA
15367-1391
US

V. Phone/Fax

Practice location:
  • Phone: 412-608-3861
  • Fax: 724-938-1569
Mailing address:
  • Phone: 724-942-5422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC000193
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPC000193
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC000193
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: