Provider Demographics
NPI:1356872717
Name:MASTNY, MICHAELA (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:MASTNY
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 1:4304 N 33RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-2748
Mailing Address - Country:US
Mailing Address - Phone:531-299-6506
Mailing Address - Fax:
Practice Address - Street 1:8031 W CENTER RD STE 307
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3134
Practice Address - Country:US
Practice Address - Phone:402-547-8869
Practice Address - Fax:402-933-9998
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111241041S0200X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor