Provider Demographics
NPI:1942563606
Name:MASSIN, SOLOMON RODRIGO II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SOLOMON
Middle Name:RODRIGO
Last Name:MASSIN
Suffix:II
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:PO BOX 50476
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-0476
Mailing Address - Country:US
Mailing Address - Phone:714-794-9765
Mailing Address - Fax:
Practice Address - Street 1:313 N BIRCH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5263
Practice Address - Country:US
Practice Address - Phone:714-794-9765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 276411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical