Provider Demographics
NPI:1073875381
Name:PHILLIPS-MASHACK, RAMEIKA (MSW)
Entity Type:Individual
Prefix:
First Name:RAMEIKA
Middle Name:
Last Name:PHILLIPS-MASHACK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 N. LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377
Mailing Address - Country:US
Mailing Address - Phone:909-437-8662
Mailing Address - Fax:
Practice Address - Street 1:2527 PARASAIL PT.
Practice Address - Street 2:
Practice Address - City:N. LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031
Practice Address - Country:US
Practice Address - Phone:909-437-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker