Provider Demographics
NPI:1588810378
Name:MASON, MELISSA JILL (MSW, LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JILL
Last Name:MASON
Suffix:
Gender:F
Credentials:MSW, LCSW-R
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:JILL
Other - Last Name:KLEINMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1068 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3659
Mailing Address - Country:US
Mailing Address - Phone:347-766-5339
Mailing Address - Fax:
Practice Address - Street 1:1068 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3659
Practice Address - Country:US
Practice Address - Phone:347-766-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1148251041C0700X
NYR0786401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical