Provider Demographics
NPI:1558552661
Name:MASANIELLO, PAMELA JEAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:MASANIELLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10372 DEMOCRACY LN
Mailing Address - Street 2:APT D
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2522
Mailing Address - Country:US
Mailing Address - Phone:703-591-2551
Mailing Address - Fax:703-591-2563
Practice Address - Street 1:10372 DEMOCRACY LN
Practice Address - Street 2:APT D
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2522
Practice Address - Country:US
Practice Address - Phone:703-591-2551
Practice Address - Fax:703-591-2563
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional