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Individual

RUSSELL MASTERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
878 109TH AVE N, NAPLES, FL 34108-1821
(239) 596-8416
(239) 513-1915
Mailing address
878 109TH AVE N, NAPLES, FL 34108-1821
(239) 596-8416
(239) 513-1915

Taxonomy

Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
FL2435
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
75199
BLUE CROSS BLUE SHIELD
FL
01
P00146358
RAILROAD MEDICARE
FL
Enumeration date
06/04/2006
Last updated
09/15/2008
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