Provider Demographics
NPI:1942333448
Name:MASTERS, ELLEN B (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:B
Last Name:MASTERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 NW 55TH BLVD
Mailing Address - Street 2:APT 303
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2803
Mailing Address - Country:US
Mailing Address - Phone:954-494-9761
Mailing Address - Fax:954-969-0779
Practice Address - Street 1:5240 NW 55TH BLVD
Practice Address - Street 2:APT 303
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2803
Practice Address - Country:US
Practice Address - Phone:954-494-9761
Practice Address - Fax:954-969-0779
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW85471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical