Provider Demographics
NPI:1205171840
Name:MASONER, SARA LEE (MS)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:LEE
Last Name:MASONER
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 1:223 FLORA LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4957
Mailing Address - Country:US
Mailing Address - Phone:408-778-5128
Mailing Address - Fax:
Practice Address - Street 1:801 HIGH ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2545
Practice Address - Country:US
Practice Address - Phone:831-818-4938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-09
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist