Provider Demographics
NPI:1295754703
Name:MASTERSON, EILEEN M (MSW,LCSW)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:M
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5836
Mailing Address - Country:US
Mailing Address - Phone:732-303-0941
Mailing Address - Fax:732-303-0941
Practice Address - Street 1:800 WASHINGTON AVE
Practice Address - Street 2:UNIT D
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5836
Practice Address - Country:US
Practice Address - Phone:732-303-0941
Practice Address - Fax:732-303-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2030101YM0800X
NJ02892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ640744Medicare ID - Type Unspecified