Provider Demographics
NPI:1689032849
Name:MASON, MICHAEL WARD (LISW-S)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WARD
Last Name:MASON
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 WYNDHAM PARK N
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8463
Mailing Address - Country:US
Mailing Address - Phone:614-620-2240
Mailing Address - Fax:
Practice Address - Street 1:2715 SAWBURY BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4583
Practice Address - Country:US
Practice Address - Phone:614-766-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI27001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI 2700OtherOHIO CSWMFT BOARD