Provider Demographics
NPI:1932223096
Name:MASTERS, RON (LCSW)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:MASTERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2353
Mailing Address - Country:US
Mailing Address - Phone:812-337-3691
Mailing Address - Fax:812-337-2379
Practice Address - Street 1:91 W MOUND ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-7049
Practice Address - Country:US
Practice Address - Phone:812-988-2258
Practice Address - Fax:812-988-2257
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004520A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000392366OtherANTHEM BC BS
235180CMedicare ID - Type Unspecified