Provider Demographics
NPI:1063609808
Name:MASSIE, ELISE DION (PHD)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:DION
Last Name:MASSIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 N JANSSEN AVE
Mailing Address - Street 2:UNIT #3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2822
Mailing Address - Country:US
Mailing Address - Phone:773-529-3717
Mailing Address - Fax:
Practice Address - Street 1:180 N STETSON AVE
Practice Address - Street 2:SUITE 3150
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-6710
Practice Address - Country:US
Practice Address - Phone:312-228-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical