Provider Demographics
NPI:1629528633
Name:MASI, SUSAN TORRILLO (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:TORRILLO
Last Name:MASI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13975 MANCHESTER RD STE 7
Mailing Address - Street 2:BALLWIN
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4500
Mailing Address - Country:US
Mailing Address - Phone:314-303-0790
Mailing Address - Fax:
Practice Address - Street 1:13975 MANCHESTER RD
Practice Address - Street 2:SUITE 7
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4500
Practice Address - Country:US
Practice Address - Phone:314-303-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014034653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional