Provider Demographics
NPI:1346776325
Name:MASTERSON, TIM (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:
Last Name:MASTERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:TIMOTHY
Other - Middle Name:K
Other - Last Name:MASTERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191032
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-1032
Mailing Address - Country:US
Mailing Address - Phone:916-677-6836
Mailing Address - Fax:
Practice Address - Street 1:2386 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4741
Practice Address - Country:US
Practice Address - Phone:916-351-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254561041C0700X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No305S00000XManaged Care OrganizationsPoint of Service