Healthcare Provider Details

I. General information

NPI: 1861807596
Provider Name (Legal Business Name): TONI-ANN MASTANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NORTH RD
POUGHKEEPSIE NY
12601-1328
US

IV. Provider business mailing address

230 NORTH RD
POUGHKEEPSIE NY
12601-1328
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-2700
  • Fax: 845-790-2199
Mailing address:
  • Phone: 845-486-2700
  • Fax: 845-790-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP92336
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: