Provider Demographics
NPI:1992868806
Name:MASON, KELLY MURPHY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MURPHY
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 EAST 90TH ST.
Mailing Address - Street 2:#3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-725-7850
Mailing Address - Fax:
Practice Address - Street 1:315 E 90TH ST
Practice Address - Street 2:#3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5269
Practice Address - Country:US
Practice Address - Phone:212-725-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073573-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical