MEDICARE: DR. JOHN D. MASSELLA ED.D, LPC, NCC, CCS,

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	101Y00000X	Counselor	PC000193	PA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	PC000193	PA
3	101YM0800X	Mental Health Counselor	PC000193	PA

General Provider Information

NPI Number	:	1235187196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN D. MASSELLA ED.D, LPC, NCC, CCS,

Provider Business Mailing Address
First Line	:	115 CASTLEBROOKE DR
Second Line	:
City	:	VENETIA
State	:	PA
Zip	:	15367-1391
Country	:	US
Telephone Number	:	724-942-5422
Fax Number	:

Provider Business Practice Location Address
First Line	:	4160 WASHINGTON RD
Second Line	:	SUITE 201
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2533
Country	:	US
Telephone Number	:	412-608-3861
Fax Number	:	724-938-1569

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	04/28/2015

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