Provider Demographics
NPI:1518124882
Name:MASCARENAS, IDIDA (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:IDIDA
Middle Name:
Last Name:MASCARENAS
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:MS
Other - First Name:DEE DEE
Other - Middle Name:
Other - Last Name:MASCARENAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LMFT
Mailing Address - Street 1:1191 E WALNUT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1868
Mailing Address - Country:US
Mailing Address - Phone:626-568-5813
Mailing Address - Fax:626-795-1172
Practice Address - Street 1:1191 E WALNUT ST STE 101
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1868
Practice Address - Country:US
Practice Address - Phone:626-568-5813
Practice Address - Fax:626-795-1172
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25028106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist