Provider Demographics
NPI:1013194620
Name:MASSIE, BETTY (PHD)
Entity Type:Individual
Prefix:MISS
First Name:BETTY
Middle Name:
Last Name:MASSIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WAYMAN LN
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1625
Mailing Address - Country:US
Mailing Address - Phone:207-288-5081
Mailing Address - Fax:207-288-7024
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1648
Practice Address - Country:US
Practice Address - Phone:207-288-8604
Practice Address - Fax:207-288-7024
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432820999Medicaid
MEPS1214OtherMAINE LICENSE
000431201Medicare PIN
MEOTH000Medicare UPIN
ME432820999Medicaid