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General NPI Number Information
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NPI Number | 1205215084
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Entity Type | Individual
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Provider Name | TANIKA MASSE
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Gender | Female
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 69-09A 186 LANE
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City | FRESH MEADOW
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State | NY
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Zip | 11365
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Country | US
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Telephone | 347-285-9871
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Fax |
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Provider Business Mailing Address
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Address Line | 535 8TH AVE FL 2
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City | NEW YORK
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State | NY
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Zip | 10018-4332
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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