Provider Demographics
NPI:1134740996
Name:MASSE, CALVIN IVY
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:IVY
Last Name:MASSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13217 STRAVINSKY DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6838
Mailing Address - Country:US
Mailing Address - Phone:443-653-0250
Mailing Address - Fax:
Practice Address - Street 1:1000 MOUNT OLIVET RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2210
Practice Address - Country:US
Practice Address - Phone:202-440-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling