Provider Demographics
NPI:1255007670
Name:MASON, ELIZABETH DUTILLY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:DUTILLY
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LIZABETH
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1558 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-3238
Mailing Address - Country:US
Mailing Address - Phone:203-384-3377
Mailing Address - Fax:203-378-8578
Practice Address - Street 1:1558 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-3238
Practice Address - Country:US
Practice Address - Phone:203-384-3377
Practice Address - Fax:203-378-8578
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT116371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical