Healthcare Provider Details

I. General information

NPI: 1114831054
Provider Name (Legal Business Name): PRIMA NEUROPSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 N 44TH ST STE 415
PHOENIX AZ
85018-7251
US

IV. Provider business mailing address

29455 N CAVE CREEK RD STE 118-527
CAVE CREEK AZ
85331-3245
US

V. Phone/Fax

Practice location:
  • Phone: 602-675-0335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARISSA MASCORRO
Title or Position: OWNER
Credential: PSYD
Phone: 602-675-0335