Provider Demographics
NPI:1902958416
Name:MASTOR, PAGE SCHAPER (PHD)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:SCHAPER
Last Name:MASTOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 78 BOX 9516
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-9736
Mailing Address - Country:US
Mailing Address - Phone:505-737-9352
Mailing Address - Fax:
Practice Address - Street 1:1337 GUSDORF RD
Practice Address - Street 2:SUITE H
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6294
Practice Address - Country:US
Practice Address - Phone:505-737-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0858103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39907538Medicaid