Provider Demographics
NPI:1649996497
Name:MASTERSON, DAWN VICTORIA (BA, LMT)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:VICTORIA
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:BA, LMT
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:VICTORIA
Other - Last Name:MASTERSON-PALOMBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:55 LANTERN PARK DR APT 5
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-1871
Mailing Address - Country:US
Mailing Address - Phone:203-707-8301
Mailing Address - Fax:
Practice Address - Street 1:50 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1402
Practice Address - Country:US
Practice Address - Phone:203-568-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007904225700000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist