Provider Demographics
NPI:1992288211
Name:MASON, LESLIE JEANNE (LICSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JEANNE
Last Name:MASON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-2544
Mailing Address - Country:US
Mailing Address - Phone:508-295-4856
Mailing Address - Fax:
Practice Address - Street 1:43 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2544
Practice Address - Country:US
Practice Address - Phone:508-295-4856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103594104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA103594-SW-LCSWOtherMA BOARD OF REGISTRATION OF SOCIAL WORKERS