Provider Demographics
NPI:1013062322
Name:MASSEY, ANNETTE BLANCHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:BLANCHARD
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 1:2780 SW 155TH LN
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1515
Mailing Address - Country:US
Mailing Address - Phone:954-536-9032
Mailing Address - Fax:
Practice Address - Street 1:1601 N PALM AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3200
Practice Address - Country:US
Practice Address - Phone:954-536-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5138103TC0700X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR79106Medicare UPIN
FL59663BMedicare ID - Type Unspecified