Provider Demographics
NPI:1033534532
Name:MASSEY, BEVERLY (LISW-S, LICDC-CS,)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:LISW-S, LICDC-CS,
Other - Prefix:PROF
Other - First Name:BEVERLY
Other - Middle Name:ANN
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW-S, LICDC-CS
Mailing Address - Street 1:6840 KENTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3815
Mailing Address - Country:US
Mailing Address - Phone:513-242-4430
Mailing Address - Fax:
Practice Address - Street 1:6840 KENTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3815
Practice Address - Country:US
Practice Address - Phone:513-242-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH943894101YA0400X
OH0002701103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst