Provider Demographics
NPI:1508471947
Name:MASSOTT, DENNIS (LSW)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:MASSOTT
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RUSTLEAF LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19055-1421
Mailing Address - Country:US
Mailing Address - Phone:267-979-5392
Mailing Address - Fax:
Practice Address - Street 1:2 RUSTLEAF LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-1421
Practice Address - Country:US
Practice Address - Phone:267-979-5392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker