Individual
NATHAN MASCARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3675 CRESTWOOD PKWY NW, DULUTH, GA 30096-1805
(404) 558-5992
Mailing address
894 FIRESIDE WAY, STONE MOUNTAIN, GA 30083-2510
(404) 558-5992
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
003091
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003091
PSYCHOLOGY LICENSE NUMBER
GA
Enumeration date
06/25/2007
Last updated
07/08/2007
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