Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35SI00192800 | NJ |
Y | 103T00000X | Psychologist | 35SI00192800 | NJ |
NPI | 1003917444 |
---|---|
Provider Name | Maria Grossi Masciandaro |
First Address | Elizabeth, NJ 07208-1451 |
Second Address | Elizabeth, NJ 07208-1451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 07/02/2014 |