Provider Demographics
NPI:1104862242
Name:MASSIMO, CHERYL ELIZABETH (CHERYL MASSIMO, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ELIZABETH
Last Name:MASSIMO
Suffix:
Gender:F
Credentials:CHERYL MASSIMO, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 ORIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-2858
Mailing Address - Country:US
Mailing Address - Phone:412-244-0563
Mailing Address - Fax:
Practice Address - Street 1:7424 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-2521
Practice Address - Country:US
Practice Address - Phone:412-818-3509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health