Provider Demographics
NPI:1447710462
Name:MASON, TONIA LYN (CADC)
Entity type:Individual
Prefix:
First Name:TONIA
Middle Name:LYN
Last Name:MASON
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OAK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:ME
Mailing Address - Zip Code:04257-1229
Mailing Address - Country:US
Mailing Address - Phone:207-418-1359
Mailing Address - Fax:
Practice Address - Street 1:150 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2035
Practice Address - Country:US
Practice Address - Phone:207-364-3549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6612101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1962591230Medicaid