Provider Demographics
NPI:1851452361
Name:MASON, STACY REED (LMSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:REED
Last Name:MASON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 NIMHAM RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3639
Mailing Address - Country:US
Mailing Address - Phone:845-216-0388
Mailing Address - Fax:845-228-4398
Practice Address - Street 1:2424 ROUTE 6
Practice Address - Street 2:BREWSTER CARMEL PROFESSIONAL BUILDING
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-2539
Practice Address - Country:US
Practice Address - Phone:845-216-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0561091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3494229OtherOXFORD PROVIDER ID