Provider Demographics
NPI:1477750206
Name:MASSEY, SUSAN T
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:T
Last Name:MASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:T
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, LCSW
Mailing Address - Street 1:635 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4210
Mailing Address - Country:US
Mailing Address - Phone:303-733-3106
Mailing Address - Fax:303-733-3106
Practice Address - Street 1:1787 SO. BELLAIRE STREET
Practice Address - Street 2:SUITE 515
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222
Practice Address - Country:US
Practice Address - Phone:303-759-5316
Practice Address - Fax:303-759-5320
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9894341041C0700X
CO275685225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO989434OtherLIC. CLIN.SOCIALWRKR
CO275685OtherREGISTERED OCCUPATIONAL T