Provider Demographics
NPI:1972167476
Name:DALE-MASON, ERICA CHRISTINE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:CHRISTINE
Last Name:DALE-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 1:106 WHEATFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2533
Mailing Address - Country:US
Mailing Address - Phone:831-915-0667
Mailing Address - Fax:
Practice Address - Street 1:106 WHEATFIELD CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2533
Practice Address - Country:US
Practice Address - Phone:831-915-0667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXEH903397800OtherBLUE SHIELD OF CALIFORNIA