Provider Demographics
NPI:1871615559
Name:MASON, MATTHEW (PHD)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12007 YELLOWBELL LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4502
Mailing Address - Country:US
Mailing Address - Phone:410-992-3823
Mailing Address - Fax:410-992-9921
Practice Address - Street 1:5525 TWIN KNOLLS RD
Practice Address - Street 2:SUITE 327
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3266
Practice Address - Country:US
Practice Address - Phone:410-992-9149
Practice Address - Fax:410-992-9921
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03933103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical