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NPI Code Detail

MEDICARE: JESSICA L MASTERSON LCSW

MEDICARE: JESSICA L 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
11041C0700XClinical Social Worker084405NY

General Provider Information

NPI Number : 1891030110
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA L MASTERSON LCSW
Provider Business Mailing Address
First Line : 197 HALF HOLLOW RD
Second Line :
City : DIX HILLS
State : NY
Zip : 11746-5859
Country : US
Telephone Number : 631-370-1836
Fax Number :
Provider Business Practice Location Address
First Line : 197 HALF HOLLOW RD
Second Line :
City : DIX HILLS
State : NY
Zip : 11746-5859
Country : US
Telephone Number : 631-370-1836
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2012
Last Update Date : 07/30/2024

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