Provider Demographics
NPI:1427216134
Name:MASSARO, CHARLES GUY (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GUY
Last Name:MASSARO
Suffix:
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 1:449 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:UNITYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17774
Mailing Address - Country:US
Mailing Address - Phone:570-951-6799
Mailing Address - Fax:570-584-4051
Practice Address - Street 1:29 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815
Practice Address - Country:US
Practice Address - Phone:570-951-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0151381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical