MEDICARE: MR. DERRICK L MASON CDCA

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	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	162683	OTHER	OH	CHEMICAL DEPENDENCY PROFESSIONALS BOARD

General Provider Information

NPI Number	:	1295239291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DERRICK L MASON CDCA

Provider Business Mailing Address
First Line	:	3207 TOD AVE NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44485-1358
Country	:	US
Telephone Number	:	330-881-0601
Fax Number	:

Provider Business Practice Location Address
First Line	:	3207 TOD AVE NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44485-1358
Country	:	US
Telephone Number	:	330-881-0601
Fax Number	:

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

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	01/09/2026

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Directions to “ MR. DERRICK L MASON CDCA” Practice Location

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