Provider Demographics
NPI:1043578487
Name:MASSIE, MARY THERESA (MSW LISW-S)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THERESA
Last Name:MASSIE
Suffix:
Gender:F
Credentials:MSW LISW-S
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:THERESA
Other - Last Name:RITCHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LISW-S
Mailing Address - Street 1:1170 OLD HENDERSON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3623
Mailing Address - Country:US
Mailing Address - Phone:614-442-7650
Mailing Address - Fax:614-442-7656
Practice Address - Street 1:1170 OLD HENDERSON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3623
Practice Address - Country:US
Practice Address - Phone:614-442-7650
Practice Address - Fax:614-442-7656
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0005567 SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical