Provider Demographics
NPI:1538935101
Name:MASSON, TERRY
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:MASSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4892
Mailing Address - Country:US
Mailing Address - Phone:973-873-5716
Mailing Address - Fax:
Practice Address - Street 1:76 MILL POND RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4892
Practice Address - Country:US
Practice Address - Phone:973-873-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No374U00000XNursing Service Related ProvidersHome Health Aide