Healthcare Provider Details

I. General information

NPI: 1336421189
Provider Name (Legal Business Name): LAINA GISELLE MASON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JORDAN RD
BEACON NY
12508-3934
US

IV. Provider business mailing address

PO BOX 95000
PHILADELPHIA PA
19195-4655
US

V. Phone/Fax

Practice location:
  • Phone: 845-467-5926
  • Fax:
Mailing address:
  • Phone: 800-444-6020
  • Fax: 845-256-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085145-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number082556
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: