Provider Demographics
NPI:1821170325
Name:MASON, JOANNE B (MS)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:B
Last Name:MASON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6147 SUTTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2738
Mailing Address - Country:US
Mailing Address - Phone:916-971-7640
Mailing Address - Fax:916-971-5711
Practice Address - Street 1:6147 SUTTER AVENUE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2738
Practice Address - Country:US
Practice Address - Phone:916-971-7640
Practice Address - Fax:916-971-5711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-08-28
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-28
Provider Licenses
StateLicense IDTaxonomies
CAMFC23495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist