Provider Demographics
NPI:1194227447
Name:YAMBA, MASSA CHINISEGAL
Entity Type:Individual
Prefix:
First Name:MASSA
Middle Name:CHINISEGAL
Last Name:YAMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WILLARD ST APT 7
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1374
Mailing Address - Country:US
Mailing Address - Phone:978-494-9243
Mailing Address - Fax:
Practice Address - Street 1:175 WILLARD ST APT 7
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-1374
Practice Address - Country:US
Practice Address - Phone:978-494-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAISSUERMedicaid