Provider Demographics
NPI:1881780435
Name:MASONE, VICTOR JR (PHD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:MASONE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7052 ROUTE 6N
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-9610
Mailing Address - Country:US
Mailing Address - Phone:814-734-3975
Mailing Address - Fax:814-734-1265
Practice Address - Street 1:7052 ROUTE 6N
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-9610
Practice Address - Country:US
Practice Address - Phone:814-734-3975
Practice Address - Fax:814-734-1265
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003450-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA429832OtherHIGHMARK
PA0011606710001Medicaid
PA429831Medicare ID - Type UnspecifiedPSYCHOLOGIST