Basic Information
| Provider Information | |||||||||
| NPI: | 1215953237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASSE | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 HOPE ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028651916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014750518 | ||||||||
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| Practice Location | |||||||||
| Address1: | 42 PARK PL | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028604010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017290080 | ||||||||
| FaxNumber: | 4017290438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW01442 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 9020011 | 05 | RI | MEDICAID |