Doctor Name: | DR. M. THERESE MASCARDO |
NPI Number: | 1003171893 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | PSY25022 |
Business Practice Address: | 1619 E Chapman Ave Fullerton, CA - 928314015 |
Business Phone Number: | 9496829474 |
Business Fax Number: | |
Mailing Address: | 1619 E Chapman Ave, FULLERTON |
State: | CA |
Postal Code: | 928314015 |
Phone Number: | 9496829474 |
Fax Number: | |
NPI Enumeration Date: | 07/09/2012 |
NPI Last Update Date: | 07/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY25022 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |