Provider Demographics
NPI:1376817551
Name:MASSEY, PHYLICIA NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PHYLICIA
Middle Name:NICOLE
Last Name:MASSEY
Suffix:
Gender:F
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:PO BOX 9024
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-0024
Mailing Address - Country:US
Mailing Address - Phone:904-323-6801
Mailing Address - Fax:904-328-1626
Practice Address - Street 1:4940 EMERSON ST STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4970
Practice Address - Country:US
Practice Address - Phone:904-323-6801
Practice Address - Fax:904-328-1626
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW134251041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker