Provider Demographics
NPI:1679321764
Name:MASCARELL, MARIETTA (SLPA)
Entity type:Individual
Prefix:
First Name:MARIETTA
Middle Name:
Last Name:MASCARELL
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18304 SW 143RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7647
Mailing Address - Country:US
Mailing Address - Phone:786-631-9094
Mailing Address - Fax:
Practice Address - Street 1:14040 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-6809
Practice Address - Country:US
Practice Address - Phone:305-651-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant