Provider Demographics
NPI:1760947071
Name:MASON, OLIVIA CENSERA
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CENSERA
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 LOW GROUND RD
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-6732
Mailing Address - Country:US
Mailing Address - Phone:434-378-2335
Mailing Address - Fax:
Practice Address - Street 1:537 LOW GROUND RD
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-6732
Practice Address - Country:US
Practice Address - Phone:434-378-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services