Provider Demographics
NPI:1154305092
Name:MASTERSON, PATRICIA JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JANE
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23360 CHAGRIN BLVD.
Mailing Address - Street 2:STE. 110
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-595-3175
Mailing Address - Fax:216-595-3178
Practice Address - Street 1:28001 CHAGRIN BLVD
Practice Address - Street 2:#212
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-292-7170
Practice Address - Fax:216-292-7182
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3080103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03885500OtherMAGELLAN
OH000000115676OtherUNICARE- LIFE AND HEALTH
OHR03080OtherSUMMA
OH000000115676OtherANTHEM
OH0463172Medicaid
OH0463172Medicaid
OHMACP10635Medicare PIN
OHR03080OtherSUMMA