Provider Demographics
NPI:1609545979
Name:MASSEY, ANDREA MARIE (MA, MED, RBT, BSS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MA, MED, RBT, BSS
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:MAHLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:531 KABLER MILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41004-2511
Mailing Address - Country:US
Mailing Address - Phone:513-519-9744
Mailing Address - Fax:
Practice Address - Street 1:334 BEECHWOOD RD STE 502
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-1611
Practice Address - Country:US
Practice Address - Phone:859-360-3006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician