Provider Demographics
NPI:1194451187
Name:MASSA, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MASSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CIRCULAR ST
Mailing Address - Street 2:
Mailing Address - City:THORNWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10594-1438
Mailing Address - Country:US
Mailing Address - Phone:914-497-9999
Mailing Address - Fax:
Practice Address - Street 1:45 CIRCULAR ST
Practice Address - Street 2:
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594-1438
Practice Address - Country:US
Practice Address - Phone:914-497-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst