Provider Demographics
NPI:1982202669
Name:MASCIOCCHI, TAYLOR N (LCSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:N
Last Name:MASCIOCCHI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 LINCOLN DR E STE E
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1500
Mailing Address - Country:US
Mailing Address - Phone:166-741-5999
Mailing Address - Fax:
Practice Address - Street 1:3000 LINCOLN DR E STE E
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1500
Practice Address - Country:US
Practice Address - Phone:667-415-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06608700104100000X
NJ44SC062582001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker