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General NPI Number Information
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NPI Number | 1063609808
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Entity Type | Individual
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Provider Name | ELISE DION MASSIE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 04/04/2010
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Provider Practice Location Address
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Address Line | 180 N STETSON AVE SUITE 3150
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City | CHICAGO
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State | IL
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Zip | 60601-6710
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Country | US
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Telephone | 312-228-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 3836 N JANSSEN AVE UNIT #3
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City | CHICAGO
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State | IL
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Zip | 60613-2822
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Country | US
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Telephone | 773-529-3717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007344
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License Number State | IL
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