Healthcare Provider Details

I. General information

NPI: 1174660716
Provider Name (Legal Business Name): MAIDA ISABEL MASCORRO PHD, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S PORTALEZA AVE
ROMA TX
78584
US

IV. Provider business mailing address

2001 ROBIN AVE
MCALLEN TX
78504-3837
US

V. Phone/Fax

Practice location:
  • Phone: 956-849-9620
  • Fax: 956-849-9620
Mailing address:
  • Phone: 956-358-6001
  • Fax: 956-358-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number96226
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14929
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: