Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 44SL05385300 | NJ |
NPI | 1003244328 |
---|---|
Provider Name | Mrs. Kasey Lyn Massa |
First Address | Camden, NJ 08103-1461 |
Second Address | Camden, NJ 08103-1461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2013 |
Last Update Date | 23/10/2013 |