Basic Information
| Provider Information | |||||||||
| NPI: | 1770776130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASSOS | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27776 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480670930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485564909 | ||||||||
| FaxNumber: | 2485564950 | ||||||||
| Practice Location | |||||||||
| Address1: | 27776 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480670930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485564909 | ||||||||
| FaxNumber: | 2485564950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 04/26/2013 | ||||||||
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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 | 6801089062 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.