Provider Demographics
NPI:1649376641
Name:MASCORRO, ROBERT ANTONIO (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTONIO
Last Name:MASCORRO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5578
Mailing Address - Country:US
Mailing Address - Phone:915-542-1582
Mailing Address - Fax:915-542-0494
Practice Address - Street 1:1310 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5578
Practice Address - Country:US
Practice Address - Phone:915-542-1582
Practice Address - Fax:915-542-0494
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX072611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000Medicare ID - Type UnspecifiedPENDING