Provider Demographics
NPI:1265923015
Name:MASON, STACEY MARY (LPC, LCADC)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:MARY
Last Name:MASON
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 WORTHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1673
Mailing Address - Country:US
Mailing Address - Phone:609-879-2028
Mailing Address - Fax:
Practice Address - Street 1:2407 RT. 71, SUITE 1
Practice Address - Street 2:UNIT 597
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1673
Practice Address - Country:US
Practice Address - Phone:609-879-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-27
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health