Healthcare Provider Details

I. General information

NPI: 1477330942
Provider Name (Legal Business Name): MARY MASOMEH FRANKLIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY MASOMEH JONAS

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SIMMONS DR
CEDAR PARK TX
78613-4577
US

IV. Provider business mailing address

220 SIMMONS DR
CEDAR PARK TX
78613-4577
US

V. Phone/Fax

Practice location:
  • Phone: 850-530-0617
  • Fax:
Mailing address:
  • Phone: 850-530-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: