Provider Demographics
NPI:1447539929
Name:MASCETTI, IRENE MONIQUE (MA, LCADC-S, CPC)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:MONIQUE
Last Name:MASCETTI
Suffix:
Gender:F
Credentials:MA, LCADC-S, CPC
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:MONIQUE
Other - Last Name:MASCETTI-KUSKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CADC-I
Mailing Address - Street 1:10792 YARMOUTH BAY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89179-1439
Mailing Address - Country:US
Mailing Address - Phone:702-672-8962
Mailing Address - Fax:
Practice Address - Street 1:10792 YARMOUTH BAY CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89179-1439
Practice Address - Country:US
Practice Address - Phone:702-672-8962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00192-LCS101YA0400X
NVCP0278101YM0800X
225400000X, 225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist