Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY25022 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY25022 | CA |
NPI | 1003171893 |
---|---|
Provider Name | Dr. M. Therese Mascardo |
First Address | Fullerton, CA 92831-4015 |
Second Address | Fullerton, CA 92831-4015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2012 |
Last Update Date | 09/07/2012 |