Provider Demographics
NPI:1639884570
Name:MASSA, ANDREA ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:ANNE
Last Name:MASSA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 FINN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-5114
Mailing Address - Country:US
Mailing Address - Phone:301-908-7439
Mailing Address - Fax:
Practice Address - Street 1:4504 FINN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5114
Practice Address - Country:US
Practice Address - Phone:301-908-7439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical