MEDICARE: ALEXANDRA MASTERSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	139551	CA

General Provider Information

NPI Number	:	1558938381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA MASTERSON LCSW

Provider Business Mailing Address
First Line	:	4661 CAPE MAY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-2223
Country	:	US
Telephone Number	:	415-680-8204
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 SANTO RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-1195
Country	:	US
Telephone Number	:	858-737-4674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/18/2026

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