Provider Demographics
NPI:1497834428
Name:MASSA, CIRO ANTHONY (LCSW LADC)
Entity Type:Individual
Prefix:
First Name:CIRO
Middle Name:ANTHONY
Last Name:MASSA
Suffix:
Gender:M
Credentials:LCSW LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PHOENIXVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06235-2419
Mailing Address - Country:US
Mailing Address - Phone:888-316-5221
Mailing Address - Fax:866-203-2138
Practice Address - Street 1:10 HIGGINS HWY STE 12
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1437
Practice Address - Country:US
Practice Address - Phone:888-316-5221
Practice Address - Fax:866-203-2138
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000204101YA0400X
CT0042541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008004012Medicaid
CT00404068904 C2770Medicare ID - Type Unspecified