Provider Demographics
NPI:1427627306
Name:MASON, TAMARA ORA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ORA
Last Name:MASON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:ORA
Other - Last Name:VILLARUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 N MADA AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2118
Mailing Address - Country:US
Mailing Address - Phone:347-349-0535
Mailing Address - Fax:
Practice Address - Street 1:16 N MADA AVE FL 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2118
Practice Address - Country:US
Practice Address - Phone:347-349-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010678-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health