Provider Demographics
NPI:1386777514
Name:MAS, CARMEN HAYDEE (PHD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:HAYDEE
Last Name:MAS
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 1:4505 WASATCH BLVD
Mailing Address - Street 2:320
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4709
Mailing Address - Country:US
Mailing Address - Phone:801-277-1200
Mailing Address - Fax:801-277-8800
Practice Address - Street 1:4505 WASATCH BLVD
Practice Address - Street 2:320
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4709
Practice Address - Country:US
Practice Address - Phone:801-277-1200
Practice Address - Fax:801-277-8800
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114239-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical