Provider Demographics
NPI:1720414295
Name:MASON, JOHNATHAN S (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:S
Last Name:MASON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PATTON DR
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2519
Mailing Address - Country:US
Mailing Address - Phone:724-699-3059
Mailing Address - Fax:
Practice Address - Street 1:2375 GARDEN WAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5209
Practice Address - Country:US
Practice Address - Phone:724-983-5454
Practice Address - Fax:724-983-5419
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130713104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker