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General NPI Number Information
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NPI Number | 1255736062
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Entity Type | Organization
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Legal Business Name | MARY R. MASTRIA, PHD, LCSW, LLC
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 57 UNION PL SUITE 212
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City | SUMMIT
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State | NJ
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Zip | 07901-2568
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Country | US
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Telephone | 908-277-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 57 UNION PL SUITE 212
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City | SUMMIT
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State | NJ
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Zip | 07901-2568
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Country | US
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Telephone | 908-277-1411
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Fax |
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Authorized Official
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Title or Position | EMPLOYER
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Name | MARY R RICCIARDI-MASTRIA
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Credential |
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Telephone | 908-277-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC04597400
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License Number State | NJ
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