Provider Demographics
NPI:1568781607
Name:MASOTTI, PERRY L (LMSW)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:L
Last Name:MASOTTI
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 1:150 MARABAC RD
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:NY
Mailing Address - Zip Code:12525-5651
Mailing Address - Country:US
Mailing Address - Phone:845-489-0052
Mailing Address - Fax:
Practice Address - Street 1:140 OLD ORANGEBURG ROAD
Practice Address - Street 2:ROCKLAND PSYCHIATRIC CENTER
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-5651
Practice Address - Country:US
Practice Address - Phone:845-489-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 080566283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital