Provider Demographics
NPI:1467820886
Name:MASON, ROBERT E II (MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:MASON
Suffix:II
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 W INDIANAPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-1334
Mailing Address - Country:US
Mailing Address - Phone:559-307-9515
Mailing Address - Fax:
Practice Address - Street 1:49774 ROAD 426 STE D
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-8691
Practice Address - Country:US
Practice Address - Phone:559-683-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist