Provider Demographics
NPI:1043345440
Name:MASTERSON-KANE, PATRICIA (LCSW, ACSW, MSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MASTERSON-KANE
Suffix:
Gender:F
Credentials:LCSW, ACSW, MSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:MARY
Other - Last Name:MASTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 AMHERST CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1302
Mailing Address - Country:US
Mailing Address - Phone:201-612-6696
Mailing Address - Fax:201-612-6696
Practice Address - Street 1:653 SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1023
Practice Address - Country:US
Practice Address - Phone:201-612-6696
Practice Address - Fax:201-612-6696
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013002001041C0700X
NYR03205711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085630TGOMedicare ID - Type Unspecified