Provider Demographics
NPI:1952417289
Name:MASSON, MARTHA CECILIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:CECILIA
Last Name:MASSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-1008
Mailing Address - Country:US
Mailing Address - Phone:909-652-0100
Mailing Address - Fax:909-652-0104
Practice Address - Street 1:9330 BASE LINE ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-5827
Practice Address - Country:US
Practice Address - Phone:909-652-0100
Practice Address - Fax:909-652-0104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13675103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical