Provider Demographics
NPI:1689290058
Name:MCCARTY-MASSONI, MARY VIRGINIA
Entity Type:Individual
Prefix:
First Name:MARY VIRGINIA
Middle Name:
Last Name:MCCARTY-MASSONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 KIERSTEN CT
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-1910
Mailing Address - Country:US
Mailing Address - Phone:410-420-8985
Mailing Address - Fax:
Practice Address - Street 1:1626 KIERSTEN CT
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-1910
Practice Address - Country:US
Practice Address - Phone:410-420-8985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician