Provider Demographics
NPI:1720626468
Name:SASSO, WAYNE XAVIER
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:XAVIER
Last Name:SASSO
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 1:21412 GLEBE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-3601
Mailing Address - Country:US
Mailing Address - Phone:703-992-5806
Mailing Address - Fax:
Practice Address - Street 1:118 LONG POND RD STE 105
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2662
Practice Address - Country:US
Practice Address - Phone:703-992-5806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health