1538207667 NPI number — JOAN S MASON LCSW CAP P A

Table of content: (NPI 1538207667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538207667 NPI number — JOAN S MASON LCSW CAP P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOAN S MASON LCSW CAP P A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHRYSALIS CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538207667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 1ST AVE
Provider Second Line Business Mailing Address:
#305
Provider Business Mailing Address City Name:
ST PETE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33706-4364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-744-4880
Provider Business Mailing Address Fax Number:
727-367-4139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3321 49TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33710-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-743-9060
Provider Business Practice Location Address Fax Number:
727-367-4139
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
727-743-9060

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW4600 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7940163 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P4510 . This is a "MEDICARE SENDER/SUBMITTER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1538207667 . This is a "MEDICARE PROVIDER ID 1538207667" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 182234000 . This is a "MAGELLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: AK104 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4014110 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Z8210Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0739204 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 512778450 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".




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