Provider Demographics
NPI:1568618882
Name:MASCARO, JOHN ANTHONY (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:MASCARO
Suffix:
Gender:M
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:PO BOX 384646
Mailing Address - Street 2:
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-4646
Mailing Address - Country:US
Mailing Address - Phone:808-226-7576
Mailing Address - Fax:808-356-0200
Practice Address - Street 1:65-1231 OPELO RD STE 4
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8376
Practice Address - Country:US
Practice Address - Phone:808-989-1503
Practice Address - Fax:808-356-0200
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI790172Medicaid