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General NPI Number Information
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NPI Number | 1154305092
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Entity Type | Individual
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Provider Name | PATRICIA JANE MASTERSON PHD
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Gender | Female
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 28001 CHAGRIN BLVD #212
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City | WOODMERE
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State | OH
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Zip | 44122
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Country | US
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Telephone | 216-292-7170
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Fax | 216-292-7182
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Provider Business Mailing Address
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Address Line | 23360 CHAGRIN BLVD. STE. 110
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City | BEACHWOOD
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State | OH
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Zip | 44122
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Country | US
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Telephone | 216-595-3175
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Fax | 216-595-3178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3080
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License Number State | OH
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