1477750206 NPI number — MS. SUSAN T. MASSEY

Table of content: MS. SUSAN T. MASSEY (NPI 1477750206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477750206 NPI number — MS. SUSAN T. MASSEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASSEY
Provider First Name:
SUSAN
Provider Middle Name:
T.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOORE
Provider Other First Name:
SUSAN
Provider Other Middle Name:
T.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.T.R., L.C.S.W
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477750206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
635 S PEARL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80209-4210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-733-3106
Provider Business Mailing Address Fax Number:
303-733-3106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1787 SO. BELLAIRE STREET
Provider Second Line Business Practice Location Address:
SUITE 515
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-759-5316
Provider Business Practice Location Address Fax Number:
303-759-5320
Provider Enumeration Date:
06/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  989434 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225XP0200X , with the licence number: 275685 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 989434 . This is a "LIC. CLIN.SOCIALWRKR" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 275685 . This is a "REGISTERED OCCUPATIONAL T" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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