Provider Demographics
NPI:1396062634
Name:THOMAS-MASSO, DEMETRIA (LMHC, NCC, CCMHC)
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:
Last Name:THOMAS-MASSO
Suffix:
Gender:F
Credentials:LMHC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4823
Mailing Address - Country:US
Mailing Address - Phone:813-750-2542
Mailing Address - Fax:813-354-2764
Practice Address - Street 1:1351 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4823
Practice Address - Country:US
Practice Address - Phone:813-750-2542
Practice Address - Fax:813-354-2764
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10905101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty