Provider Demographics
NPI:1104526425
Name:MASON, CRYSTAL MAY GALE (RBT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MAY GALE
Last Name:MASON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-8605
Mailing Address - Country:US
Mailing Address - Phone:772-233-1652
Mailing Address - Fax:
Practice Address - Street 1:6900 SW 33RD ST
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-8605
Practice Address - Country:US
Practice Address - Phone:772-233-1652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-261889106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-23-261889OtherRBT CERTIFICATION