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General NPI Number Information
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NPI Number | 1811363492
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Entity Type | Individual
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Provider Name | SAHAR TIBAH MASON LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 22101 MOROSS RD
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City | DETROIT
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State | MI
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Zip | 48236-2148
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Country | US
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Telephone | 313-343-3457
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 LIVERNOIS RD STE 500
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City | TROY
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State | MI
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Zip | 48083-1219
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Country | US
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Telephone | 248-680-8293
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | L821796
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801098213
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License Number State | MI
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