Provider Demographics
NPI:1457634891
Name:MASON, SUSAN M (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:MASON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 BRONX BLVD
Mailing Address - Street 2:ROOM 206
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1407
Mailing Address - Country:US
Mailing Address - Phone:718-304-7058
Mailing Address - Fax:718-304-7067
Practice Address - Street 1:4401 BRONX BLVD
Practice Address - Street 2:ROOM 206
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1407
Practice Address - Country:US
Practice Address - Phone:718-304-7058
Practice Address - Fax:718-304-7067
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076822-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker