Provider Demographics
NPI:1912154386
Name:MASON, JEAN ALICIA (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:ALICIA
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6357 ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6881
Mailing Address - Country:US
Mailing Address - Phone:443-474-5001
Mailing Address - Fax:
Practice Address - Street 1:6357 ARBOR WAY
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6881
Practice Address - Country:US
Practice Address - Phone:443-474-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical