Provider Demographics
NPI:1285838474
Name:MASCIARELLI, CHRISTINE (LSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MASCIARELLI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 BROUS AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3513
Mailing Address - Country:US
Mailing Address - Phone:267-252-7101
Mailing Address - Fax:
Practice Address - Street 1:9712 BUSTLETON AVE
Practice Address - Street 2:SUITE 34
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3137
Practice Address - Country:US
Practice Address - Phone:267-252-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0178751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical