Healthcare Provider Details

I. General information

NPI: 1932075371
Provider Name (Legal Business Name): ANGEL MASON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 N CALAIS RD
EAST CALAIS VT
05650-8063
US

IV. Provider business mailing address

351 N CALAIS RD
EAST CALAIS VT
05650-8063
US

V. Phone/Fax

Practice location:
  • Phone: 802-461-5719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number097.0135695
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: