Provider Demographics
NPI:1386178382
Name:MASON-JOHNSON, KEA
Entity Type:Individual
Prefix:
First Name:KEA
Middle Name:
Last Name:MASON-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W CLARKE AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1840
Mailing Address - Country:US
Mailing Address - Phone:302-430-5131
Mailing Address - Fax:302-430-5857
Practice Address - Street 1:21 W CLARKE AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1840
Practice Address - Country:US
Practice Address - Phone:302-430-5131
Practice Address - Fax:302-430-5857
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker