Provider Demographics
NPI:1811385636
Name:MASON, MARTHA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:144 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-4199
Mailing Address - Country:US
Mailing Address - Phone:850-339-8929
Mailing Address - Fax:
Practice Address - Street 1:144 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-4199
Practice Address - Country:US
Practice Address - Phone:850-339-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical