Healthcare Provider Details

I. General information

NPI: 1821810631
Provider Name (Legal Business Name): MARK MASON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E SHADY DR
NEWARK DE
19713-2859
US

IV. Provider business mailing address

65 E SHADY DR
NEWARK DE
19713-2859
US

V. Phone/Fax

Practice location:
  • Phone: 585-738-7599
  • Fax:
Mailing address:
  • Phone: 585-738-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberB1-1024
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: