Basic Information
| Provider Information | |||||||||
| NPI: | 1720414295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASON | ||||||||
| FirstName: | JOHNATHAN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 PATTON DR | ||||||||
| Address2: | |||||||||
| City: | CORAOPOLIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151082519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246993059 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2375 GARDEN WAY | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161485209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249835454 | ||||||||
| FaxNumber: | 7249835419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2013 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW130713 | PA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.