Provider Demographics
NPI:1417564725
Name:KARINEMASONE COUNSELING LCSWR, CASAC PC
Entity Type:Organization
Organization Name:KARINEMASONE COUNSELING LCSWR, CASAC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-226-0248
Mailing Address - Street 1:336 32ND ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-3231
Mailing Address - Country:US
Mailing Address - Phone:631-226-0248
Mailing Address - Fax:631-395-3207
Practice Address - Street 1:223 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2778
Practice Address - Country:US
Practice Address - Phone:631-226-0248
Practice Address - Fax:631-395-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03242913Medicaid