| Masterson Psychotherapy, Llc | |
|
4445 Corporation Ln Ste 213 Virginia Beach VA 23462-3262 | |
| (757) 237-2906 | |
| (757) 216-9655 |
| Full Name | Masterson Psychotherapy, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4445 Corporation Ln Ste 213, Virginia Beach, Virginia |
| Authorized Official Name and Position | Susan Masterson (OWNER) |
| Authorized Official Contact | 7572372906 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Masterson Psychotherapy, Llc 4445 Corporation Ln Ste 213 Virginia Beach VA 23462-3262 Ph: (757) 237-2906 | Masterson Psychotherapy, Llc 4445 Corporation Ln Ste 213 Virginia Beach VA 23462-3262 Ph: (757) 237-2906 |
| NPI Number | 1013498757 |
|---|---|
| Provider Enumeration Date | 08/21/2018 |
| Last Update Date | 04/23/2024 |
| Certification Date | 04/23/2024 |
| Medicare PECOS PAC ID | 0143561407 |
|---|---|
| Medicare Enrollment ID | O20190415001200 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013498757 | NPI | - | NPPES |
| 1851552491 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 0904006823 (Virginia) | Primary |
| Provider Name | Susan E Masterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851552491 PECOS PAC ID: 0244304095 Enrollment ID: I20080729000106 |
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