Provider Demographics
NPI:1043958515
Name:SCOT-MASON, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:SCOT-MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANITA
Other - Last Name:SCOT-MASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 GULLANE LN
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4766
Mailing Address - Country:US
Mailing Address - Phone:301-648-3213
Mailing Address - Fax:
Practice Address - Street 1:3 GULLANE LN
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-4766
Practice Address - Country:US
Practice Address - Phone:301-648-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities