Provider Demographics
NPI:1093872566
Name:MASON, CAROL LEE (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL LEE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DUMAS RD
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9497
Mailing Address - Country:US
Mailing Address - Phone:802-373-9960
Mailing Address - Fax:
Practice Address - Street 1:157 MAPLE ST.
Practice Address - Street 2:#3
Practice Address - City:JEFFERSONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05464
Practice Address - Country:US
Practice Address - Phone:802-644-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00005741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical