Provider Demographics
NPI:1346481827
Name:MASTRELLI, LOYDA MILAGROS (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LOYDA
Middle Name:MILAGROS
Last Name:MASTRELLI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-2621
Mailing Address - Country:US
Mailing Address - Phone:631-956-1720
Mailing Address - Fax:
Practice Address - Street 1:568 15TH ST
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-2621
Practice Address - Country:US
Practice Address - Phone:631-956-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058879-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker