Provider Demographics
NPI:1447749171
Name:SIOBHAN MASTERSON, LCSW.R
Entity Type:Organization
Organization Name:SIOBHAN MASTERSON, LCSW.R
Other - Org Name:SIOBHAN MASTERSON
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SIOBHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:845-608-7477
Mailing Address - Street 1:33 OLD HAVERSTRAW RD
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1915
Mailing Address - Country:US
Mailing Address - Phone:845-608-7477
Mailing Address - Fax:
Practice Address - Street 1:48 BURD ST STE 306
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3257
Practice Address - Country:US
Practice Address - Phone:845-608-7477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0719021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty