Provider Demographics
NPI:1083958367
Name:MAST, VICKI ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:ANN
Last Name:MAST
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SEMINARY PL
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1107
Mailing Address - Country:US
Mailing Address - Phone:732-317-3038
Mailing Address - Fax:914-347-4216
Practice Address - Street 1:40 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1535
Practice Address - Country:US
Practice Address - Phone:914-347-3227
Practice Address - Fax:914-347-4216
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool