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NPI Code Detail

MEDICARE: MRS. SUSAN LINDA MASTROLEO M.A.

MEDICARE: MRS. SUSAN LINDA MASTROLEO M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist#000377NY

General Provider Information

NPI Number : 1134368376
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN LINDA MASTROLEO M.A.
Provider Business Mailing Address
First Line : 917 GRANGER ROAD
Second Line :
City : SYRACUSE
State : NY
Zip : 13219-2165
Country : US
Telephone Number : 315-487-2610
Fax Number :
Provider Business Practice Location Address
First Line : 917 GRANGER ROAD
Second Line :
City : SYRACUSE
State : NY
Zip : 13219-2165
Country : US
Telephone Number : 315-487-2610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2009
Last Update Date : 02/11/2009

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