Provider Demographics
NPI:1255504874
Name:MASTROMONICO, JANE M (LPC)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:M
Last Name:MASTROMONICO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2300 APPLETREE CT NE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-1552
Mailing Address - Country:US
Mailing Address - Phone:256-539-9720
Mailing Address - Fax:256-539-9720
Practice Address - Street 1:2300 APPLETREE CT NE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-1552
Practice Address - Country:US
Practice Address - Phone:256-539-9720
Practice Address - Fax:256-539-9720
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517669OtherABBM
AL51539263OtherBCBS OF AL