Doctor Name: | MS. MARIE E MASTRACCO |
NPI Number: | 1053538926 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | LC2273 |
Business Practice Address: | 1927a York Rd Rear Building Lutherville, MD - 210934225 |
Business Phone Number: | 4434174243 |
Business Fax Number: | |
Mailing Address: | 1927a York Rd Rear, LUTHERVILLE |
State: | MD |
Postal Code: | 210934225 |
Phone Number: | 4434174243 |
Fax Number: | 3152450352 |
NPI Enumeration Date: | 04/20/2007 |
NPI Last Update Date: | 03/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LC2273 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |