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NPI Code Detail

MEDICARE: MS. PHYLICIA NICOLE MASSEY LCSW

MEDICARE:  MS. PHYLICIA NICOLE MASSEY  LCSW
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
11041C0700XClinical Social WorkerSW13425FL
2104100000XSocial Worker

General Provider Information

NPI Number : 1376817551
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PHYLICIA NICOLE MASSEY LCSW
Provider Business Mailing Address
First Line : PO BOX 9024
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32208-0024
Country : US
Telephone Number : 904-323-6801
Fax Number : 904-328-1626
Provider Business Practice Location Address
First Line : 4940 EMERSON ST STE 103
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-4970
Country : US
Telephone Number : 904-323-6801
Fax Number : 904-328-1626
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2012
Last Update Date : 08/16/2022

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Directions to “ MS. PHYLICIA NICOLE MASSEY LCSW” Practice Location

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