Provider Demographics
NPI:1871207845
Name:MASON, ABENA
Entity type:Individual
Prefix:
First Name:ABENA
Middle Name:
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 1:2117 BUFFALO RD STE 176
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 CLUB HOUSE DR
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14428-9645
Practice Address - Country:US
Practice Address - Phone:646-387-1389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor