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General NPI Number Information
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NPI Number | 1568618882
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Entity Type | Individual
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Provider Name | JOHN ANTHONY MASCARO PHD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 65-1231 OPELO RD STE 4
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City | KAMUELA
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State | HI
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Zip | 96743-8376
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Country | US
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Telephone | 808-989-1503
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Fax | 808-356-0200
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Provider Business Mailing Address
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Address Line | PO BOX 384646
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City | WAIKOLOA
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State | HI
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Zip | 96738-4646
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Country | US
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Telephone | 808-226-7576
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Fax | 808-356-0200
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT-199
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License Number State | HI
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