Healthcare Provider Details

I. General information

NPI: 1548355563
Provider Name (Legal Business Name): MARY C MASELLIS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20740 S ELLSWORTH RD
QUEEN CREEK AZ
85242-9058
US

IV. Provider business mailing address

2978 E PARKVIEW DR
GILBERT AZ
85297-6438
US

V. Phone/Fax

Practice location:
  • Phone: 480-987-5993
  • Fax: 480-987-7499
Mailing address:
  • Phone: 480-987-5993
  • Fax: 480-987-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: