Provider Demographics
NPI:1851417166
Name:MASSEY, ROXIE F (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROXIE
Middle Name:F
Last Name:MASSEY
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:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95696-0759
Mailing Address - Country:US
Mailing Address - Phone:770-337-3179
Mailing Address - Fax:
Practice Address - Street 1:145 BARNHILL DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8736
Practice Address - Country:US
Practice Address - Phone:770-337-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19416103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA711671864AMedicaid
GA68BBGKWMedicare ID - Type Unspecified