Provider Demographics
NPI:1578785580
Name:DE MASTER, CONRAD NEIL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CONRAD
Middle Name:NEIL
Last Name:DE MASTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAIN AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:OCEAN GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07756-2117
Mailing Address - Country:US
Mailing Address - Phone:201-447-0880
Mailing Address - Fax:
Practice Address - Street 1:20 MAIN AVE APT 4B
Practice Address - Street 2:
Practice Address - City:OCEAN GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07756-2117
Practice Address - Country:US
Practice Address - Phone:201-669-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC060501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
634524Medicare ID - Type Unspecified