Provider Demographics
NPI:1881614725
Name:DE MASTER, ISABEL R (LCSW)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:R
Last Name:DE MASTER
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 1:83 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1715
Mailing Address - Country:US
Mailing Address - Phone:201-327-2717
Mailing Address - Fax:201-327-4105
Practice Address - Street 1:71 FRANKLIN TPKE
Practice Address - Street 2:FLOOR 2 SUITE 4
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1851
Practice Address - Country:US
Practice Address - Phone:201-447-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00128800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
99380OtherUBH
141381OtherVALUE OPTIONS
5643121OtherAETNA
P1536350OtherOXFORD
141381OtherVALUE OPTIONS