MEDICARE: MS. TERESA A MASI MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC45922	CA

General Provider Information

NPI Number	:	1114158078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA A MASI MFT

Provider Business Mailing Address
First Line	:	1145 GAYLEY AVE
Second Line	:	SUITE 322
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3423
Country	:	US
Telephone Number	:	310-208-7187
Fax Number	:	213-405-5095

Provider Business Practice Location Address
First Line	:	1145 GAYLEY AVE
Second Line	:	SUITE 322
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3423
Country	:	US
Telephone Number	:	310-208-7187
Fax Number	:	213-405-5095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	07/27/2009

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