MEDICARE: MS. CHARLENE W. MASON-REESE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC00586800	NJ

General Provider Information

NPI Number	:	1144371899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARLENE W. MASON-REESE LCSW

Provider Business Mailing Address
First Line	:	31 NEWFIELD ST
Second Line	:	#2
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-5410
Country	:	US
Telephone Number	:	201-725-1807
Fax Number	:	908-820-4290

Provider Business Practice Location Address
First Line	:	31 NEWFIELD ST
Second Line	:	#2
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-5410
Country	:	US
Telephone Number	:	201-725-1807
Fax Number	:	908-820-4290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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