Provider Demographics
NPI:1215957048
Name:MASSOTH, SHARON R (MSW)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:R
Last Name:MASSOTH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 HILLWINDS N
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-9076
Mailing Address - Country:US
Mailing Address - Phone:203-980-3993
Mailing Address - Fax:
Practice Address - Street 1:77 HAZARD AVE UNIT M2
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3890
Practice Address - Country:US
Practice Address - Phone:203-980-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0020591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0000037868OtherMENTAL HEALTH NET
CT54296OtherCIGNA BEHAVIORAL HEALTH
CT135006OtherMAGELLAN
CT188117OtherHEALTH MANAGEMENT CENTER
CT221176OtherCOM PSYCH
CTA993734OtherVALUE OPTIONS
CTP1090932OtherOXFORD HEALTH
CT54296OtherCIGNA BEHAVIORAL HEALTH
CTP1090932OtherOXFORD HEALTH