Provider Demographics
NPI:1598155483
Name:MASSENA, ANDRE J (MSW)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:J
Last Name:MASSENA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 EXECUTIVE CENTER DR APT 29
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-8692
Mailing Address - Country:US
Mailing Address - Phone:561-889-4798
Mailing Address - Fax:
Practice Address - Street 1:728 EXECUTIVE CENTER DRIVE APT 29
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-889-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health