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General NPI Number Information
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NPI Number | 1316112956
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Entity Type | Individual
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Provider Name | RE' MASON PH.D., MAC, CAP
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Gender | Male
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 8695 COLLEGE PKWY SUIT 252
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City | FORT MYERS
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State | FL
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Zip | 33919-4890
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Country | US
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Telephone | 239-489-4705
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Fax | 239-489-2732
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Provider Business Mailing Address
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Address Line | 8695 COLLEGE PKWY SUIT 252
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City | FORT MYERS
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State | FL
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Zip | 33919-4890
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Country | US
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Telephone | 239-489-4705
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Fax | 239-489-2732
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | CAP 117
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | MAC 500085
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License Number State | FL
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