Provider Demographics
NPI:1194041806
Name:MASSIE, BRENDA MARIE (LMSW, MA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:MASSIE
Suffix:
Gender:F
Credentials:LMSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 82ND ST
Mailing Address - Street 2:APT. 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-7301
Mailing Address - Country:US
Mailing Address - Phone:917-579-5833
Mailing Address - Fax:
Practice Address - Street 1:71 W 23RD ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4102
Practice Address - Country:US
Practice Address - Phone:212-576-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst