Provider Demographics
NPI:1447543004
Name:MASTRIANO, BARBARA P (CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:P
Last Name:MASTRIANO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 JOHN F. KENNEDY BLVD.
Mailing Address - Street 2:APT. 2418
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:609-504-6124
Mailing Address - Fax:
Practice Address - Street 1:ONE WEST ELM ST. SUITE 100
Practice Address - Street 2:MERCYLIFE PROGRAM
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428
Practice Address - Country:US
Practice Address - Phone:610-567-5218
Practice Address - Fax:610-567-6375
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL-000817-L235Z00000X
#00168948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist