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General NPI Number Information
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NPI Number | 1992961023
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Entity Type | Individual
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Provider Name | JESSICA MASSARO LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 2680 SLATERVILLE RD
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City | SLATERVILLE SPRINGS
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State | NY
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Zip | 14881-9412
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Country | US
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Telephone | 607-220-9689
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Fax |
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Provider Business Mailing Address
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Address Line | 2680 SLATERVILLE RD
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City | SLATERVILLE SPRINGS
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State | NY
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Zip | 14881-9412
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Country | US
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Telephone | 607-220-9689
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 077385
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 079523-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R079523-1
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License Number State | NY
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