Provider Demographics
NPI:1255466371
Name:MASSINGER, WILLIAM J IV (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:MASSINGER
Suffix:IV
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 LAKESIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966
Mailing Address - Country:US
Mailing Address - Phone:215-264-4550
Mailing Address - Fax:
Practice Address - Street 1:504 LAKESIDE DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:215-354-0777
Practice Address - Fax:215-354-0772
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW008523L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA242694251OtherUBH
PAMA1312953OtherHIGHMARK BLUE SHIELD
PA2006808000OtherPERSONAL CHOICE