Provider Demographics
NPI:1366179830
Name:MASSARO, BRIANA
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:MASSARO
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 1:61 N FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6058
Mailing Address - Country:US
Mailing Address - Phone:516-319-8028
Mailing Address - Fax:
Practice Address - Street 1:61 N FORDHAM RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-6058
Practice Address - Country:US
Practice Address - Phone:516-319-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2025-09-15
Deactivation Date:2023-01-28
Deactivation Code:
Reactivation Date:2025-09-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYHX0006294926Medicaid