Provider Demographics
NPI:1265510648
Name:MASENG, NANCY ELISE (LISW CP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ELISE
Last Name:MASENG
Suffix:
Gender:F
Credentials:LISW CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 MILLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1827
Mailing Address - Country:US
Mailing Address - Phone:803-256-2606
Mailing Address - Fax:803-254-4406
Practice Address - Street 1:3204 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1827
Practice Address - Country:US
Practice Address - Phone:803-256-2606
Practice Address - Fax:803-254-4406
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC001455104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ312700281Medicare UPIN