Provider Demographics
NPI:1407576226
Name:MASCARO, GREGORY (LPC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:MASCARO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 MONMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-1524
Mailing Address - Country:US
Mailing Address - Phone:732-552-8041
Mailing Address - Fax:
Practice Address - Street 1:1125 MONMOUTH AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-1524
Practice Address - Country:US
Practice Address - Phone:732-552-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00825600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional