Provider Demographics
NPI:1912134958
Name:MASON, SUSAN GAIL (MS,SPEECH-LANGUAGE)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GAIL
Last Name:MASON
Suffix:
Gender:F
Credentials:MS,SPEECH-LANGUAGE
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:SCHAEFER
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 TOWNHOUSE PLACE
Mailing Address - Street 2:APT. 2L
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:212-691-1806
Mailing Address - Fax:
Practice Address - Street 1:330 SEVENTH AVENUE
Practice Address - Street 2:20TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-691-1806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002085-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist