Provider Demographics
NPI:1982110532
Name:MASON, KATHERINE LAURA (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LAURA
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LAURA
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1035 SAN PABLO AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2277
Mailing Address - Country:US
Mailing Address - Phone:510-859-3406
Mailing Address - Fax:
Practice Address - Street 1:1035 SAN PABLO AVE STE 8
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2277
Practice Address - Country:US
Practice Address - Phone:510-859-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA829161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA82916OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES