Provider Demographics
NPI:1083790380
Name:MASCALO, ALISON (PHD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MASCALO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12695 MCMANUS BLVD
Mailing Address - Street 2:BLDG. 8
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4435
Mailing Address - Country:US
Mailing Address - Phone:757-877-7700
Mailing Address - Fax:
Practice Address - Street 1:12695 MCMANUS BLVD
Practice Address - Street 2:BLDG. 8
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4435
Practice Address - Country:US
Practice Address - Phone:757-877-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001389103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7730322Medicaid