MEDICARE: MARK P MASI PSYD

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	103TC0700X	Clinical Psychologist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21623208	OTHER	IL	BLUE SHIELD OF IL

General Provider Information

NPI Number	:	1992745921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK P MASI PSYD

Provider Business Mailing Address
First Line	:	3295 ARLINGTON HEIGHTS RD
Second Line	:	SUITE 114
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1565
Country	:	US
Telephone Number	:	847-253-6698
Fax Number	:

Provider Business Practice Location Address
First Line	:	3295 ARLINGTON HEIGHTS RD
Second Line	:	SUITE 114
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1565
Country	:	US
Telephone Number	:	847-253-6698
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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Directions to “ MARK P MASI PSYD” Practice Location

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