MEDICARE: MS. VALERIE MASON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	010204	NY

General Provider Information

NPI Number	:	1417105479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERIE MASON

Provider Business Mailing Address
First Line	:	488 PUTNAM AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-1003
Country	:	US
Telephone Number	:	718-687-8481
Fax Number	:

Provider Business Practice Location Address
First Line	:	488 PUTNAM AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-1003
Country	:	US
Telephone Number	:	718-687-8481
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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Directions to “ MS. VALERIE MASON ” Practice Location

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