Provider Demographics
NPI:1023086436
Name:MASON, THERESA C (LCSW BCD)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:C
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PERSOMA, PC
Mailing Address - Street 2:2540 MONROEVILLE BLVD.
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146
Mailing Address - Country:US
Mailing Address - Phone:412-823-5155
Mailing Address - Fax:412-823-8262
Practice Address - Street 1:PERSOMA, PC
Practice Address - Street 2:2450 MONROEVILLE BLVD.
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146
Practice Address - Country:US
Practice Address - Phone:412-823-5155
Practice Address - Fax:412-823-8262
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0132311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002097OtherHIGHMARK BC/BS
PA200054OtherVALUE OPTIONS
PA002097Medicare UPIN