Provider Demographics
NPI:1639699366
Name:MASSONNE, KATHY (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MASSONNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3139
Mailing Address - Country:US
Mailing Address - Phone:260-426-3347
Mailing Address - Fax:260-424-2248
Practice Address - Street 1:333 E LEWIS ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3139
Practice Address - Country:US
Practice Address - Phone:260-426-3347
Practice Address - Fax:260-424-2248
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003465A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical