Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | CAP 117 | FL |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | MAC 500085 | FL |
NPI | 1316112956 |
---|---|
Provider Name | Dr. Re' Mason |
First Address | Fort Myers, FL 33919-4890 |
Second Address | Fort Myers, FL 33919-4890 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 24/04/2008 |