Provider Demographics
NPI:1598126187
Name:MASON, EDWARD (N/A)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 SEAVIEW AVE SOUTH BEACH PSYCHIATRIC CENTER
Mailing Address - Street 2:HEALTH HOME CARE DEPT
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-668-8158
Mailing Address - Fax:718-668-8070
Practice Address - Street 1:777 SEAVIEW AVE SOUTH BEACH PSYCHIATRIC CENTER
Practice Address - Street 2:HEALTH HOME CARE DEPT
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-668-8158
Practice Address - Fax:718-668-8070
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00769306Medicaid