Provider Demographics
NPI:1700447729
Name:MASS, ROSLYN
Entity type:Individual
Prefix:
First Name:ROSLYN
Middle Name:
Last Name:MASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W COTTON ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-4407
Mailing Address - Country:US
Mailing Address - Phone:337-831-1365
Mailing Address - Fax:
Practice Address - Street 1:100 ASMA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3868
Practice Address - Country:US
Practice Address - Phone:337-456-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator