Provider Demographics
NPI:1992745921
Name:MASI, MARK P (PSYD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:MASI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3295 ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1565
Mailing Address - Country:US
Mailing Address - Phone:847-253-6698
Mailing Address - Fax:
Practice Address - Street 1:3295 ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 114
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1565
Practice Address - Country:US
Practice Address - Phone:847-253-6698
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21623208OtherBLUE SHIELD OF IL