| Doctor Name: | MOIRA GOGGINS MASTRO |
| NPI Number: | 1023238193 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | 072742 |
| Business Practice Address: | 13105 Main Rd Mattituck, NY - 119523214 |
| Business Phone Number: | 5169934934 |
| Business Fax Number: | 6317142620 |
| Mailing Address: | Po Box 600, MATTITUCK |
| State: | NY |
| Postal Code: | 119520600 |
| Phone Number: | 5169934934 |
| Fax Number: | 6317142620 |
| NPI Enumeration Date: | 04/30/2007 |
| NPI Last Update Date: | 02/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 072742 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |