Provider Demographics
NPI:1770040297
Name:MASTERSON, KATHLEEN (LPC, NCC, ACS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:LPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 STATE ROUTE 27 STE 2B
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1514
Mailing Address - Country:US
Mailing Address - Phone:848-900-1510
Mailing Address - Fax:848-243-0474
Practice Address - Street 1:3176 STATE ROUTE 27 STE 2B
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1514
Practice Address - Country:US
Practice Address - Phone:848-900-1510
Practice Address - Fax:848-243-0474
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00384700101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor