Provider Demographics
NPI:1205215084
Name:MASSE, TANIKA
Entity Type:Individual
Prefix:
First Name:TANIKA
Middle Name:
Last Name:MASSE
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 1:535 8TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:69-09A 186 LANE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:347-285-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2018-07-26
Deactivation Date:2017-08-25
Deactivation Code:
Reactivation Date:2018-07-03
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 103TS0200X
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional