Healthcare Provider Details

I. General information

NPI: 1770801573
Provider Name (Legal Business Name): JUDITH L. MASAKI MS, LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 HOWLAND WILSON RD NE
WARREN OH
44484-2115
US

IV. Provider business mailing address

885 HOWLAND WILSON RD NE
WARREN OH
44484-2115
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-2107
  • Fax: 330-856-2107
Mailing address:
  • Phone: 330-856-2107
  • Fax: 330-856-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0001906SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: