Healthcare Provider Details

I. General information

NPI: 1275897480
Provider Name (Legal Business Name): AMANDA MASON PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 COBBLESTONE DR
SAN RAFAEL CA
94903-1510
US

IV. Provider business mailing address

184 COBBLESTONE DR
SAN RAFAEL CA
94903-1510
US

V. Phone/Fax

Practice location:
  • Phone: 415-370-4256
  • Fax:
Mailing address:
  • Phone: 415-370-4256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY26711
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: