Provider Demographics
NPI:1003917444
Name:MASCIANDARO, MARIA GROSSI (PSY D)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GROSSI
Last Name:MASCIANDARO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:REGINA
Other - Last Name:GROSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:890 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1451
Mailing Address - Country:US
Mailing Address - Phone:908-351-2892
Mailing Address - Fax:908-351-1646
Practice Address - Street 1:890 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1451
Practice Address - Country:US
Practice Address - Phone:908-351-2892
Practice Address - Fax:908-351-1646
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00192800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA607892Medicare ID - Type Unspecified