Healthcare Provider Details

I. General information

NPI: 1962097923
Provider Name (Legal Business Name): BIANCA CHRISTINE MASON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 W MADISON ST STE 1
CHICAGO IL
60612-2425
US

IV. Provider business mailing address

2446 W MADISON ST STE 1
CHICAGO IL
60612-2425
US

V. Phone/Fax

Practice location:
  • Phone: 919-747-4472
  • Fax:
Mailing address:
  • Phone: 919-747-4472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC017056
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149041221
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: