Provider Demographics
NPI:1992968119
Name:MASSEY, JOANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 E DE SOTO ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-3337
Mailing Address - Country:US
Mailing Address - Phone:850-439-2100
Mailing Address - Fax:850-439-2122
Practice Address - Street 1:1221 E DE SOTO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3337
Practice Address - Country:US
Practice Address - Phone:850-439-2100
Practice Address - Fax:850-439-2122
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5216103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59861OtherBLUE CROSS AND BLUE SHIELD OF FLORIDA