Provider Demographics
NPI:1588019608
Name:MASTERGEORGE, STACEY LYNN (MS, MFT)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LYNN
Last Name:MASTERGEORGE
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-1120
Mailing Address - Country:US
Mailing Address - Phone:860-614-3419
Mailing Address - Fax:860-356-7104
Practice Address - Street 1:271 TREMONT ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1120
Practice Address - Country:US
Practice Address - Phone:860-614-3419
Practice Address - Fax:860-356-7104
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No251S00000XAgenciesCommunity/Behavioral Health