Provider Demographics
NPI:1578003034
Name:MASSARO, MARY (MS, NCPSYA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MASSARO
Suffix:
Gender:F
Credentials:MS, NCPSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 S MOUNTAIN AVE
Mailing Address - Street 2:#19
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1750
Mailing Address - Country:US
Mailing Address - Phone:973-568-8112
Mailing Address - Fax:
Practice Address - Street 1:12 S MOUNTAIN AVE
Practice Address - Street 2:#19
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1750
Practice Address - Country:US
Practice Address - Phone:973-568-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor