Provider Demographics
NPI:1366571655
Name:MASTRONE, CARON LANGAN (PHD)
Entity type:Individual
Prefix:
First Name:CARON
Middle Name:LANGAN
Last Name:MASTRONE
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 1:2450A OLD SHELL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3020
Mailing Address - Country:US
Mailing Address - Phone:251-478-3044
Mailing Address - Fax:251-476-9055
Practice Address - Street 1:2450A OLD SHELL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3020
Practice Address - Country:US
Practice Address - Phone:251-478-3044
Practice Address - Fax:251-476-9055
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1023103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000046975Medicare ID - Type Unspecified
ALS82039Medicare UPIN