MEDICARE: DR. BARBARA JEAN MASSETTE LCPC

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	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1982889960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA JEAN MASSETTE LCPC

Provider Business Mailing Address
First Line	:	12641 VINCENNES RD
Second Line	:
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-1609
Country	:	US
Telephone Number	:	708-597-3065
Fax Number	:	866-883-9952

Provider Business Practice Location Address
First Line	:	12641 VINCENNES RD
Second Line	:
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-1609
Country	:	US
Telephone Number	:	708-597-3065
Fax Number	:	866-883-9952

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

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	01/08/2008

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