Provider Demographics
NPI:1679881833
Name:MASSEY, MICHELLE ELAINE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELAINE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22112 78TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7935
Mailing Address - Country:US
Mailing Address - Phone:206-954-5413
Mailing Address - Fax:
Practice Address - Street 1:22112 78TH PL W
Practice Address - Street 2:#101
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7935
Practice Address - Country:US
Practice Address - Phone:206-954-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600612891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical