Provider Demographics
NPI:1649589714
Name:MASTERSON, WALTER JOSEPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:JOSEPH
Last Name:MASTERSON
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 1:200 RECTOR PL
Mailing Address - Street 2:23L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1107
Mailing Address - Country:US
Mailing Address - Phone:646-745-7755
Mailing Address - Fax:
Practice Address - Street 1:200 RECTOR PL
Practice Address - Street 2:23L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1107
Practice Address - Country:US
Practice Address - Phone:646-745-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079067-11041C0700X
NY0815451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical