Provider Demographics
NPI:1255736062
Name:MARY R. MASTRIA, PHD, LCSW, LLC
Entity type:Organization
Organization Name:MARY R. MASTRIA, PHD, LCSW, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICCIARDI-MASTRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-277-1411
Mailing Address - Street 1:57 UNION PL
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2568
Mailing Address - Country:US
Mailing Address - Phone:908-277-1411
Mailing Address - Fax:
Practice Address - Street 1:57 UNION PL
Practice Address - Street 2:SUITE 212
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2568
Practice Address - Country:US
Practice Address - Phone:908-277-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045974001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty