Provider Demographics
NPI:1295804870
Name:NEUMANN-MASCIS, ANDREA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:NEUMANN-MASCIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANDREAS
Other - Middle Name:
Other - Last Name:NEUMANN-MASCIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:70 WYVERN ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2134
Mailing Address - Country:US
Mailing Address - Phone:508-308-3242
Mailing Address - Fax:617-553-1945
Practice Address - Street 1:3464 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2665
Practice Address - Country:US
Practice Address - Phone:508-308-3242
Practice Address - Fax:617-553-1945
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303546Medicaid
MA1303546Medicaid
MA221867Medicare Oscar/Certification