Individual
DR. STEFAN MASSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2472 PASS RD, BILOXI, MS 39531-2838
(228) 388-9303
(228) 388-9306
Mailing address
2472 PASS RD, BILOXI, MS 39531-2838
(228) 388-9303
(228) 388-9306
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
35-579
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121755
—
MS
01
—
11428838W
CAQH
MS
Enumeration date
10/02/2006
Last updated
07/08/2007
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