Provider Demographics
NPI:1861873200
Name:MASSARO, RAQUEL M
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:M
Last Name:MASSARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:M
Other - Last Name:ARAUJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10013 WATER WORKS LANE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578
Mailing Address - Country:US
Mailing Address - Phone:813-290-8560
Mailing Address - Fax:813-435-2033
Practice Address - Street 1:10013 WATER WORKS LANE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578
Practice Address - Country:US
Practice Address - Phone:813-290-8560
Practice Address - Fax:813-435-2033
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health