Provider Demographics
NPI:1689719965
Name:HASKINS, DERON MASON (MA, RAS)
Entity Type:Individual
Prefix:MR
First Name:DERON
Middle Name:MASON
Last Name:HASKINS
Suffix:
Gender:M
Credentials:MA, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 W 148TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-2717
Mailing Address - Country:US
Mailing Address - Phone:310-217-9338
Mailing Address - Fax:
Practice Address - Street 1:100 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4417
Practice Address - Country:US
Practice Address - Phone:562-427-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACERT# H0412241242101YA0400X
101YM0800X
TXLBSW# 21021104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23706OtherDV COUNSELOR
CAH0412241242OtherREGISTERED ADDICTION SPEC