Provider Demographics
NPI:1700937182
Name:MASTERLEO, JOSEPH CHARLES (LCSW - DCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CHARLES
Last Name:MASTERLEO
Suffix:
Gender:M
Credentials:LCSW - DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 DEWITT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2890
Mailing Address - Country:US
Mailing Address - Phone:314-415-4880
Mailing Address - Fax:315-469-4474
Practice Address - Street 1:112 DEWITT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2890
Practice Address - Country:US
Practice Address - Phone:314-415-4880
Practice Address - Fax:315-469-4474
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR021307 - 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5112OtherEXCELLUS, BLUECROSS-BLUES
NY317553OtherMVP HEALTHCARE
NY5112OtherEXCELLUS, BLUECROSS-BLUES