Provider Demographics
NPI:1336681139
Name:MASON, JAMIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 SW 24TH PL
Mailing Address - Street 2:307
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1163
Mailing Address - Country:US
Mailing Address - Phone:954-770-2973
Mailing Address - Fax:
Practice Address - Street 1:5930 SW 24TH PL
Practice Address - Street 2:307
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1163
Practice Address - Country:US
Practice Address - Phone:954-770-2973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 2385106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist