Provider Demographics
NPI:1306160775
Name:PATRICIA J MASTERSON PHD LLC
Entity type:Organization
Organization Name:PATRICIA J MASTERSON PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELING PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-292-7170
Mailing Address - Street 1:23360 CHAGRIN BLVD.
Mailing Address - Street 2:STE. 110
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-595-3175
Mailing Address - Fax:216-595-3178
Practice Address - Street 1:28001 CHAGRIN BLVD
Practice Address - Street 2:212
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4559
Practice Address - Country:US
Practice Address - Phone:216-292-7170
Practice Address - Fax:216-292-7182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3080103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3037118Medicaid
OH9388881Medicare PIN