Provider Demographics
NPI:1255117131
Name:MASSOUD, ALIXANDRA
Entity type:Individual
Prefix:
First Name:ALIXANDRA
Middle Name:
Last Name:MASSOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALIA
Other - Middle Name:
Other - Last Name:MASSOUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18 BRANTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-8004
Mailing Address - Country:US
Mailing Address - Phone:401-258-0773
Mailing Address - Fax:
Practice Address - Street 1:18 BRANTWOOD RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-8004
Practice Address - Country:US
Practice Address - Phone:401-258-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health