=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003914649
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN MICHAEL SASSO MA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 08/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 DERBY ST STE 16 BRIAN SASSO/ LEVIN & ZANGRILLO
-----------------------------------------------------
City | HINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02043-4047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-740-1546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 SOHIER ST
-----------------------------------------------------
City | COHASSET
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02025-1377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-383-9691
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 7714
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------