Basic Information
| Provider Information | |||||||||
| NPI: | 1912177296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASON CLEMENT | ||||||||
| FirstName: | HOLLYCE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 WEST ESPLANADE AVE | ||||||||
| Address2: | STE 213 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048385716 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2121 RIDGELAKE | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047826352 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2008 | ||||||||
| LastUpdateDate: | 03/03/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4520 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.