Healthcare Provider Details

I. General information

NPI: 1720414295
Provider Name (Legal Business Name): JOHNATHAN S MASON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 GARDEN WAY
HERMITAGE PA
16148-5209
US

IV. Provider business mailing address

201 PATTON DR
CORAOPOLIS PA
15108-2519
US

V. Phone/Fax

Practice location:
  • Phone: 724-983-5454
  • Fax: 724-983-5419
Mailing address:
  • Phone: 724-699-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW130713
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: