Basic Information
| Provider Information | |||||||||
| NPI: | 1124164611 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASTERSON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 198 ESSEX ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH HAMILTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019822404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784684933 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 LEDGEWOOD PL | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ROCKLAND | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023701075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818716550 | ||||||||
| FaxNumber: | 7818715973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 4827 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | LM1045 | 01 | MA | BLUE CROSS | OTHER |