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General NPI Number Information
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NPI Number | 1114831054
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Entity Type | Organization
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Legal Business Name | PRIMA NEUROPSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 2999 N 44TH ST STE 415
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City | PHOENIX
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State | AZ
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Zip | 85018-7251
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Country | US
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Telephone | 602-675-0335
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Fax |
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Provider Business Mailing Address
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Address Line | 29455 N CAVE CREEK RD STE 118-527
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City | CAVE CREEK
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State | AZ
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Zip | 85331-3245
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARISSA MASCORRO
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Credential | PSYD
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Telephone | 602-675-0335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State | NULL
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