Jennifer T. Mascolo, PSYD, NCSP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

4617 Issued in NJ

Practice address

18 Kings Hwy Ste 202
Middletown, NJ 07748-2509

Phone

(917) 757-7748

NPI assigned

Aug 1, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1225648645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 SCHINDLER LN",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "077482446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 KINGS HWY STE 202",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "077482509",
            "telephone_number": "917-757-7748"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "245 W 107th St Apt 1E",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100253049",
            "country_code": "US",
            "telephone_number": "917-757-7748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASCOLO",
        "first_name": "JENNIFER",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "PSYD, NCSP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-01",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "015836",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "4617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Middletown, NJ
• Providers in Middletown, NJ by specialty
• Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.