MEDICARE: MRS. CYNTHIA LOU MASONJONES L.C.S.W.

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	58.007286	CT

General Provider Information

NPI Number	:	1356668040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA LOU MASONJONES L.C.S.W.

Provider Business Mailing Address
First Line	:	11 MAIN ST
Second Line	:	6
City	:	MYSTIC
State	:	CT
Zip	:	06355-3654
Country	:	US
Telephone Number	:	860-572-4969
Fax Number	:	860-572-5767

Provider Business Practice Location Address
First Line	:	11 MAIN ST
Second Line	:	6
City	:	MYSTIC
State	:	CT
Zip	:	06355-3654
Country	:	US
Telephone Number	:	860-572-4969
Fax Number	:	860-572-5767

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

Provider Enumeration Date	:	04/21/2010
Last Update Date	:	04/21/2010

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