Provider Demographics
NPI:1861500332
Name:MASTERSON, MAUREEN L
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:L
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:M
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0160
Mailing Address - Country:US
Mailing Address - Phone:360-682-4059
Mailing Address - Fax:360-678-3636
Practice Address - Street 1:390 NE MIDWAY BLVD
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2642
Practice Address - Country:US
Practice Address - Phone:360-682-4059
Practice Address - Fax:360-678-3636
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00017962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC00017962OtherCOUNSELOR REGISTRATION