Provider Demographics
NPI:1851904981
Name:MASSELAM, GEORGE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:MASSELAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 ROSEMARY ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3256
Mailing Address - Country:US
Mailing Address - Phone:781-752-9157
Mailing Address - Fax:
Practice Address - Street 1:285 ROSEMARY ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3256
Practice Address - Country:US
Practice Address - Phone:781-752-9157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0002249041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical