Provider Demographics
NPI:1083740336
Name:MASTICK, NINA L (MSW)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:L
Last Name:MASTICK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:NINA
Other - Middle Name:ROSELY
Other - Last Name:MASTICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:413 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2274
Mailing Address - Country:US
Mailing Address - Phone:231-947-1497
Mailing Address - Fax:231-386-5834
Practice Address - Street 1:413 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2274
Practice Address - Country:US
Practice Address - Phone:231-947-1497
Practice Address - Fax:231-386-5834
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0898819OtherBCBSM
MI1083740336OtherCOMMERCIAL
MI0M48370Medicare PIN