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General NPI Number Information
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NPI Number | 1427216134
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Entity Type | Individual
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Provider Name | CHARLES GUY MASSARO LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 29 E MAIN ST
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City | BLOOMSBURG
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State | PA
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Zip | 17815
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Country | US
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Telephone | 570-951-6799
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Fax |
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Provider Business Mailing Address
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Address Line | 449 RIDGE RD
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City | UNITYVILLE
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State | PA
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Zip | 17774
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Country | US
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Telephone | 570-951-6799
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Fax | 570-584-4051
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW015138
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License Number State | PA
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