Provider Demographics
NPI:1467771725
Name:MASSULI, JESSICA (CADC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MASSULI
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 COLLEGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-8713
Mailing Address - Country:US
Mailing Address - Phone:302-735-7790
Mailing Address - Fax:302-735-3654
Practice Address - Street 1:1241 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-8713
Practice Address - Country:US
Practice Address - Phone:302-735-7790
Practice Address - Fax:302-735-3654
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE114964101YA0400X
DE948101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)