Provider Demographics
NPI:1801209895
Name:HARDGRAVE MASSENA, LINDSAY (LISW, BCBA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:HARDGRAVE MASSENA
Suffix:
Gender:F
Credentials:LISW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-1306
Mailing Address - Country:US
Mailing Address - Phone:556-563-7878
Mailing Address - Fax:556-563-1259
Practice Address - Street 1:1011 DAVIS ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-1306
Practice Address - Country:US
Practice Address - Phone:556-563-7878
Practice Address - Fax:556-563-1259
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IA101027103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303414Medicaid