Provider Demographics
NPI:1124359260
Name:MASSEY, CARLA (PHD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MASSEY
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 1:307 7TH AVE RM 2203
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6025
Mailing Address - Country:US
Mailing Address - Phone:212-463-9172
Mailing Address - Fax:
Practice Address - Street 1:307 7TH AVE RM 2203
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6025
Practice Address - Country:US
Practice Address - Phone:212-463-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11109-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist