MEDICARE: WANDA Y MASSEY LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	680111566210	MI

General Provider Information

NPI Number	:	1013763242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA Y MASSEY LMSW

Provider Business Mailing Address
First Line	:	3240 VASSAR ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3571
Country	:	US
Telephone Number	:	313-766-8389
Fax Number	:

Provider Business Practice Location Address
First Line	:	24500 FORD RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3182
Country	:	US
Telephone Number	:	734-655-0051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	04/17/2025

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