Provider Demographics
NPI:1538207667
Name:JOAN S MASON LCSW CAP P A
Entity type:Organization
Organization Name:JOAN S MASON LCSW CAP P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-743-9060
Mailing Address - Street 1:200 1ST AVE
Mailing Address - Street 2:#305
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-4364
Mailing Address - Country:US
Mailing Address - Phone:727-744-4880
Mailing Address - Fax:727-367-4139
Practice Address - Street 1:3321 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2145
Practice Address - Country:US
Practice Address - Phone:727-743-9060
Practice Address - Fax:727-367-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW46001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7940163OtherAETNA
FLP4510OtherMEDICARE SENDER/SUBMITTER
FL1538207667OtherMEDICARE PROVIDER ID 1538207667
FL182234000OtherMAGELLAN
FLAK104OtherMEDICARE GROUP PTAN
FL4014110OtherHUMANA
FLZ8210ZOtherMEDICARE PTAN
FL0739204OtherCIGNA
512778450OtherUNITED BEHAVIORAL HEALTH
FL4014110OtherHUMANA
FLAK104OtherMEDICARE GROUP PTAN