Provider Demographics
NPI:1104864057
Name:MASON, SANDRA LEE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DULANEY VALLEY RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2600
Mailing Address - Country:US
Mailing Address - Phone:410-832-2729
Mailing Address - Fax:
Practice Address - Street 1:901 DULANEY VALLEY RD
Practice Address - Street 2:SUITE 129
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2600
Practice Address - Country:US
Practice Address - Phone:410-832-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00904104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker