Provider Demographics
NPI:1174660716
Name:MASCORRO, MAIDA ISABEL (PHD, NCC, LPC)
Entity type:Individual
Prefix:DR
First Name:MAIDA
Middle Name:ISABEL
Last Name:MASCORRO
Suffix:
Gender:F
Credentials:PHD, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 ROBIN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3837
Mailing Address - Country:US
Mailing Address - Phone:956-358-6001
Mailing Address - Fax:956-358-6001
Practice Address - Street 1:106 S PORTALEZA AVE
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584
Practice Address - Country:US
Practice Address - Phone:956-849-9620
Practice Address - Fax:956-849-9620
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96226101Y00000X
TX14929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6119LCOtherBLUE CROSS BLUE SHIELD
TX855958OtherSUPERIOR HEALTH PLAN