Provider Demographics
NPI:1922267137
Name:MASCIA, CAROLINE ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:ANN
Last Name:MASCIA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10071 SW 15TH PL
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7402
Mailing Address - Country:US
Mailing Address - Phone:954-854-4357
Mailing Address - Fax:
Practice Address - Street 1:10071 SW 15TH PL
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-7402
Practice Address - Country:US
Practice Address - Phone:954-424-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890969500Medicaid