Provider Demographics
NPI:1659798064
Name:MASSLER, MARTIN
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:MASSLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1429
Mailing Address - Country:US
Mailing Address - Phone:201-444-5874
Mailing Address - Fax:201-444-5874
Practice Address - Street 1:169 NEW STREET
Practice Address - Street 2:
Practice Address - City:WEST PAWLET
Practice Address - State:VT
Practice Address - Zip Code:05775
Practice Address - Country:US
Practice Address - Phone:201-247-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT098.0000166102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst