Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | NY |
NPI | 1083958367 |
---|---|
Provider Name | Dr. Vicki Ann Mast |
First Address | New Brunswick, NJ 08901-1107 |
Second Address | Hawthorne, NY 10532-1535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2012 |
Last Update Date | 27/11/2012 |