Provider Demographics
NPI:1356536734
Name:MASCIOLA, CYNTHIA BRADEN (MFC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:BRADEN
Last Name:MASCIOLA
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5506 W 123RD PL
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3433
Mailing Address - Country:US
Mailing Address - Phone:310-259-9923
Mailing Address - Fax:
Practice Address - Street 1:5506 W 123RD PL
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3433
Practice Address - Country:US
Practice Address - Phone:310-259-9923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39309106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist