Healthcare Provider Details

I. General information

NPI: 1073915393
Provider Name (Legal Business Name): GAETANA ROSEL MASSARO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 BROOKSIDE DR UNIT 3
BRATTLEBORO VT
05301-4281
US

IV. Provider business mailing address

39 BROOKSIDE DR UNIT 3
BRATTLEBORO VT
05301-4281
US

V. Phone/Fax

Practice location:
  • Phone: 312-623-9296
  • Fax:
Mailing address:
  • Phone: 312-623-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0137039
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.006921
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: