Provider Demographics
NPI:1639917271
Name:MASSE, SCOTT THOMAS (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:MASSE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 FARMINGTON AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1953
Mailing Address - Country:US
Mailing Address - Phone:860-677-5570
Mailing Address - Fax:
Practice Address - Street 1:323 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-8902
Practice Address - Country:US
Practice Address - Phone:203-729-6901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13493363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health