Carolyn D Massengale -Hasan, 171M00000X

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

190703 Issued in OH

Practice address

1400 E 55TH St
Cleveland, OH 44103-1304

Phone

(216) 369-8550

NPI assigned

Nov 14, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• National Youth Advocate Program, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rockford, IL
  • NPI 1841943495
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1710490628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E 55TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441031304",
            "telephone_number": "216-369-8550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E 55TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441031304",
            "telephone_number": "216-369-8550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASSENGALE -HASAN",
        "first_name": "CAROLYN",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "171M00000X",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-14",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "190703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mikayla Leeann Massa, AUD
• Ivana Massabki
• Faysal Massad, MD
• Danielle Massarella, MD
• Jessica Massari, D.D.S
• Harvey L Massengale, LSW
• Mariel Massey
• Melissa Massey
• Masseys Loving Care LLC
• Mary Evelyn Massie-Story, MD

• Addiction (Substance Use Disorder) Counselor in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.