Provider Demographics
NPI:1083111033
Name:MASTERSON, REBECCA DANIELLE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DANIELLE
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 10TH AVE N STE 601
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6618
Mailing Address - Country:US
Mailing Address - Phone:561-823-3178
Mailing Address - Fax:561-516-8861
Practice Address - Street 1:2290 10TH AVE N STE 601
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6618
Practice Address - Country:US
Practice Address - Phone:561-823-3178
Practice Address - Fax:561-516-8861
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLSW207691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor