Provider Demographics
NPI:1710258223
Name:MASKIN, CAROL ANTOINETTE (MFT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANTOINETTE
Last Name:MASKIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 EL DORADO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2560
Mailing Address - Country:US
Mailing Address - Phone:626-932-4041
Mailing Address - Fax:
Practice Address - Street 1:566 EL DORADO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2560
Practice Address - Country:US
Practice Address - Phone:626-932-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist