Provider Demographics
NPI:1023760261
Name:MASON, MARISSA A (LICSW)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:A
Last Name:MASON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:MCFADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-0749
Mailing Address - Country:US
Mailing Address - Phone:802-851-8619
Mailing Address - Fax:802-851-8716
Practice Address - Street 1:607 WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8652
Practice Address - Country:US
Practice Address - Phone:802-888-8320
Practice Address - Fax:802-888-8136
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01345081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical