Provider Demographics
NPI:1407848260
Name:MASON, JENNIFER ANDERSON (M S W L C S W)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANDERSON
Last Name:MASON
Suffix:
Gender:F
Credentials:M S W L C S W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2680
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41012-2680
Mailing Address - Country:US
Mailing Address - Phone:859-578-3204
Mailing Address - Fax:859-578-3273
Practice Address - Street 1:318 MONTJOY ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:KY
Practice Address - Zip Code:41040-1132
Practice Address - Country:US
Practice Address - Phone:859-654-6988
Practice Address - Fax:859-654-3763
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5891041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID