Healthcare Provider Details

I. General information

NPI: 1033781307
Provider Name (Legal Business Name): BAILEY ELIZABETH MASTERSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LODI ST
SYRACUSE NY
13203-2826
US

IV. Provider business mailing address

8834 DAYLIGHT DR
LIVERPOOL NY
13090-1594
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-5383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112615-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: