Active NPI
Bryant Odell Massenburg, LCSW
- Social Worker
- Ft Riley, KS
National Provider Identifier
1194938571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 0904006561
- Practice address
- 650 Huebner Rd
Ft Riley, KS 66442-4030 - Phone
- (757) 535-6301
- NPI assigned
- May 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904006561 | VA | |
| Social Worker | 104100000X | 0904006561 | VA | Primary |
Addresses
Primary practice location
650 Huebner Rd
Ft Riley, KS 66442-4030
Mailing address
650 Huebner Rd
Ft Riley, KS 66442-4030
Phone (757) 535-6301
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0904006561 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695945600000",
"number": "1194938571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 HUEBNER RD",
"city": "FT RILEY",
"state": "KS",
"postal_code": "664424030",
"telephone_number": "757-535-6301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 HUEBNER RD",
"city": "FT RILEY",
"state": "KS",
"postal_code": "664424030",
"telephone_number": "757-535-6301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASSENBURG",
"first_name": "BRYANT",
"middle_name": "ODELL",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-08",
"last_updated": "2023-09-29",
"certification_date": "2023-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904006561",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "VA",
"license": "0904006561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Riley, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.