Provider Demographics
NPI:1255854006
Name:MASCARI, LAUREN H (PHD, LP, NCC)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:H
Last Name:MASCARI
Suffix:
Gender:F
Credentials:PHD, LP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 W FOREST HOME AVENUE SUITE A
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3227
Mailing Address - Country:US
Mailing Address - Phone:414-424-5000
Mailing Address - Fax:262-725-4000
Practice Address - Street 1:1316 W FOREST HOME AVENUE SUITE A
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3227
Practice Address - Country:US
Practice Address - Phone:414-424-5000
Practice Address - Fax:262-725-4000
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3375-226101Y00000X, 101YM0800X
731257101YP2500X
WI4062.57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255854006Medicaid