Provider Demographics
NPI:1023720232
Name:MASTROMONACO, CLAIRE MARIE (LMT)
Entity type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:MARIE
Last Name:MASTROMONACO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1929
Mailing Address - Country:US
Mailing Address - Phone:626-725-0058
Mailing Address - Fax:
Practice Address - Street 1:111 WEST PKWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1929
Practice Address - Country:US
Practice Address - Phone:203-367-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001022225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist