Healthcare Provider Details

I. General information

NPI: 1174879480
Provider Name (Legal Business Name): KARLA A MASON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARLA A TUCKER LCSW

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N 12TH AVE BLDG B
ARCADIA FL
34266
US

IV. Provider business mailing address

101 RIVERFRONT BLVD STE 710
BRADENTON FL
34205-8812
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-1242
  • Fax:
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-845-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW10719
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW10719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: