Provider Demographics
NPI:1689798258
Name:MASTERSON, CATHERINE (PHD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EAST 17TH STREET
Mailing Address - Street 2:APT. 7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3676
Mailing Address - Country:US
Mailing Address - Phone:212-254-5625
Mailing Address - Fax:
Practice Address - Street 1:300 OLD COUNTRY ROAD
Practice Address - Street 2:SUITE 91
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4112
Practice Address - Country:US
Practice Address - Phone:516-747-1844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008977103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV51011Medicare ID - Type Unspecified