Provider Demographics
NPI:1336303171
Name:MASTON, CYNTHIA ALYCE (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ALYCE
Last Name:MASTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 N HABANA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7144
Mailing Address - Country:US
Mailing Address - Phone:813-872-7582
Mailing Address - Fax:813-873-9591
Practice Address - Street 1:928 22ND AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-2934
Practice Address - Country:US
Practice Address - Phone:727-327-7656
Practice Address - Fax:727-322-2130
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW79271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111454700Medicaid