Healthcare Provider Details

I. General information

NPI: 1154305092
Provider Name (Legal Business Name): PATRICIA JANE MASTERSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28001 CHAGRIN BLVD #212
WOODMERE OH
44122
US

IV. Provider business mailing address

23360 CHAGRIN BLVD. STE. 110
BEACHWOOD OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 216-292-7170
  • Fax: 216-292-7182
Mailing address:
  • Phone: 216-595-3175
  • Fax: 216-595-3178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: