Provider Demographics
NPI:1407865462
Name:MASK, EUGENE JASON (MSW)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:JASON
Last Name:MASK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5TH AVE. AND ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-5128
Mailing Address - Country:US
Mailing Address - Phone:708-202-2058
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE. AND ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5128
Practice Address - Country:US
Practice Address - Phone:708-202-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical