Provider Demographics
NPI:1033690862
Name:MASSEY, ANTHONY LOUIS (MED, EDS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LOUIS
Last Name:MASSEY
Suffix:
Gender:M
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E NEW YORK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-5527
Mailing Address - Country:US
Mailing Address - Phone:386-738-5543
Mailing Address - Fax:386-734-8330
Practice Address - Street 1:120 E NEW YORK AVE STE B
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5527
Practice Address - Country:US
Practice Address - Phone:386-738-5543
Practice Address - Fax:386-734-8330
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT2824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health