Provider Demographics
NPI:1962508598
Name:MASTERS, JONATHAN EDWARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:EDWARD
Last Name:MASTERS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W BROAD ST STE 205
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5570
Mailing Address - Country:US
Mailing Address - Phone:484-747-6066
Mailing Address - Fax:480-383-6678
Practice Address - Street 1:227 W BROAD ST STE 205
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5570
Practice Address - Country:US
Practice Address - Phone:484-747-6066
Practice Address - Fax:480-383-6678
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ63115Medicare ID - Type Unspecified