Provider Demographics
NPI:1548355563
Name:MASELLIS, MARY C (MA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:MASELLIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2978 E PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-6438
Mailing Address - Country:US
Mailing Address - Phone:480-987-5993
Mailing Address - Fax:480-987-7499
Practice Address - Street 1:20740 S ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-9058
Practice Address - Country:US
Practice Address - Phone:480-987-5993
Practice Address - Fax:480-987-7499
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool