Healthcare Provider Details

I. General information

NPI: 1407848260
Provider Name (Legal Business Name): JENNIFER ANDERSON MASON M S W L C S W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 MONTJOY ST
FALMOUTH KY
41040-1132
US

IV. Provider business mailing address

PO BOX 2680
COVINGTON KY
41012-2680
US

V. Phone/Fax

Practice location:
  • Phone: 859-654-6988
  • Fax: 859-654-3763
Mailing address:
  • Phone: 859-578-3204
  • Fax: 859-578-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number589
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number589
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: