Provider Demographics
NPI:1639474919
Name:MASON, CHANEL PATRICIA (LICSW)
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:PATRICIA
Last Name:MASON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3956 PENNSYLVANIA AVE SE APT 304
Mailing Address - Street 2:SE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1717
Mailing Address - Country:US
Mailing Address - Phone:202-290-3850
Mailing Address - Fax:
Practice Address - Street 1:3956 PENNSYLVANIA AVE SE APT 304
Practice Address - Street 2:SE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1717
Practice Address - Country:US
Practice Address - Phone:202-290-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500783151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical