MEDICARE: MS. JESSICA MASSARO LCSW-R

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	077385	NY
2	1041C0700X	Clinical Social Worker	079523-1	NY
3	1041C0700X	Clinical Social Worker	R079523-1	NY

General Provider Information

NPI Number	:	1992961023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA MASSARO LCSW-R

Provider Business Mailing Address
First Line	:	2680 SLATERVILLE RD
Second Line	:
City	:	SLATERVILLE SPRINGS
State	:	NY
Zip	:	14881-9412
Country	:	US
Telephone Number	:	607-220-9689
Fax Number	:

Provider Business Practice Location Address
First Line	:	2680 SLATERVILLE RD
Second Line	:
City	:	SLATERVILLE SPRINGS
State	:	NY
Zip	:	14881-9412
Country	:	US
Telephone Number	:	607-220-9689
Fax Number	:

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

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	10/02/2024

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