Provider Demographics
NPI:1891924759
Name:MASSED, AMBER LYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:MASSED
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SCHOOLHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-2418
Mailing Address - Country:US
Mailing Address - Phone:401-648-8846
Mailing Address - Fax:866-786-0077
Practice Address - Street 1:200 SCHOOLHOUSE LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-2418
Practice Address - Country:US
Practice Address - Phone:401-648-8846
Practice Address - Fax:866-786-0077
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW021941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1891902759Medicaid