Provider Demographics
NPI:1538441753
Name:MASON, YAMILLE PENAGOS (LCAT)
Entity type:Individual
Prefix:MRS
First Name:YAMILLE
Middle Name:PENAGOS
Last Name:MASON
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 52ND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1027
Mailing Address - Country:US
Mailing Address - Phone:917-449-7477
Mailing Address - Fax:
Practice Address - Street 1:1841 BROADWAY 4 FL
Practice Address - Street 2:INSTITUTE FOR COMTEMPORARY PSYCHOTHERAPY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:917-449-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05001417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health