Provider Demographics
NPI:1194984484
Name:MASCARELLA, CARLTON PATRICK (MA)
Entity type:Individual
Prefix:MR
First Name:CARLTON
Middle Name:PATRICK
Last Name:MASCARELLA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14360 SAINT ANDREWS DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4358
Mailing Address - Country:US
Mailing Address - Phone:760-243-5417
Mailing Address - Fax:760-513-4696
Practice Address - Street 1:14360 SAINT ANDREWS DR
Practice Address - Street 2:SUITE 11
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4358
Practice Address - Country:US
Practice Address - Phone:760-243-5417
Practice Address - Fax:760-513-4696
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 29791106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist