Provider Demographics
NPI:1013763242
Name:MASSEY, WANDA Y (LMSW)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:Y
Last Name:MASSEY
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:Y
Other - Last Name:BEYDOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:3240 VASSAR ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3571
Mailing Address - Country:US
Mailing Address - Phone:313-766-8389
Mailing Address - Fax:
Practice Address - Street 1:24500 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3182
Practice Address - Country:US
Practice Address - Phone:734-655-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680111566210104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker