Provider Demographics
NPI:1558671735
Name:MAST, STEPHEN F (LMSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:MAST
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 QUEENS BLVD STE 812
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4522
Mailing Address - Country:US
Mailing Address - Phone:718-896-6500
Mailing Address - Fax:347-868-6427
Practice Address - Street 1:9525 QUEENS BLVD STE 812
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4522
Practice Address - Country:US
Practice Address - Phone:718-896-6500
Practice Address - Fax:347-868-6427
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081999-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker