Provider Demographics
NPI:1558639930
Name:MASON, WENDY ANN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ANN
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24 WALDEN GLN
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-9234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 WALDEN GLN
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-9234
Practice Address - Country:US
Practice Address - Phone:518-899-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY753341041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool