Doctor Name: | CARRIE G MASTRONARDE |
NPI Number: | 1144416322 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 2006009196 |
Business Practice Address: | 340 N Chamber Dr Fredericktown, MO - 636457947 |
Business Phone Number: | 5735173951 |
Business Fax Number: | 8665170663 |
Mailing Address: | 340 N Chamber Dr, FREDERICKTOWN |
State: | MO |
Postal Code: | 636457947 |
Phone Number: | 5735173951 |
Fax Number: | 8665170663 |
NPI Enumeration Date: | 09/20/2007 |
NPI Last Update Date: | 08/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2006009196 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |