MEDICARE: ANDREW N MASSA APSS/CADCA1

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	175T00000X	Peer Specialist	1216416	KY

General Provider Information

NPI Number	:	1902754591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW N MASSA APSS/CADCA1

Provider Business Mailing Address
First Line	:	11 VIRGINIA AVE
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1119
Country	:	US
Telephone Number	:	859-227-2870
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 EXECUTIVE DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4869
Country	:	US
Telephone Number	:	859-252-1939
Fax Number	:

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

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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