Provider Demographics
NPI:1316112956
Name:MASON, RE' (PHD, MAC, CAP)
Entity type:Individual
Prefix:DR
First Name:RE'
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:PHD, MAC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8695 COLLEGE PKWY
Mailing Address - Street 2:SUIT 252
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4890
Mailing Address - Country:US
Mailing Address - Phone:239-489-4705
Mailing Address - Fax:239-489-2732
Practice Address - Street 1:8695 COLLEGE PKWY
Practice Address - Street 2:SUIT 252
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4890
Practice Address - Country:US
Practice Address - Phone:239-489-4705
Practice Address - Fax:239-489-2732
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 117103TA0400X
FLMAC 500085103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)