Provider Demographics
NPI:1861602625
Name:MASON, M RENE (LCSW)
Entity type:Individual
Prefix:MS
First Name:M
Middle Name:RENE
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:RENE
Other - Last Name:MASON-FRANKLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:340 11TH ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4055
Mailing Address - Country:US
Mailing Address - Phone:917-568-4462
Mailing Address - Fax:
Practice Address - Street 1:421 11TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4307
Practice Address - Country:US
Practice Address - Phone:917-568-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR044250-1-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3185552OtherOXFORD