Provider Demographics
NPI:1811074453
Name:MASTEN, JAMES ELIOT (LCSW, PHD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ELIOT
Last Name:MASTEN
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 16TH ST STE M1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3789
Mailing Address - Country:US
Mailing Address - Phone:212-691-2173
Mailing Address - Fax:
Practice Address - Street 1:205 E 16TH ST STE M1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3789
Practice Address - Country:US
Practice Address - Phone:212-691-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051205-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4G161Medicare ID - Type UnspecifiedSOCIAL WORK LICENSE