Healthcare Provider Details

I. General information

NPI: 1821468182
Provider Name (Legal Business Name): ASHLEY M. MASTEN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 N CHARLES ST PAVILION NORTH, SUITE 100
BALTIMORE MD
21204-5826
US

IV. Provider business mailing address

6501 N CHARLES ST ROOM D225
BALTIMORE MD
21204-6819
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2707
  • Fax: 443-849-8066
Mailing address:
  • Phone: 410-938-3464
  • Fax: 410-938-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17333
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: