Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | LPC-4857 | ID |
NPI | 1003190216 |
---|---|
Provider Name | Mrs. Nicole M Massari |
First Address | Brentwood, CA 94513-5389 |
Second Address | Brentwood, CA 94513-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2011 |
Last Update Date | 06/09/2016 |