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General NPI Number Information
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NPI Number | 1417671314
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Entity Type | Individual
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Provider Name | CHRISTINA MASCUCH LSW, LCADC
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Gender | Female
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 670 US HIGHWAY 1 N
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City | ISELIN
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State | NJ
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Zip | 08830-2629
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Country | US
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Telephone | 732-510-1140
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Fax | 732-218-9749
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Provider Business Mailing Address
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Address Line | 262 MONTCLAIR AVE
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City | NEWARK
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State | NJ
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Zip | 07104-2314
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Country | US
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Telephone | 973-689-4399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL06257800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00249600
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License Number State | NJ
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