| Entity Name: | JOAN S. MASON, LCSW CAP, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 04 Jan 2000 (25 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | P00000000830 |
| FEI/EIN Number | 593167685 |
| Address: | 200 1ST AVE, 305, PASS-A-GRILLE, FL, 33706 |
| Mail Address: | 200 1ST AVE, 305, PASS-A-GRILLE, FL, 33706 |
| ZIP code: | 33706 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538207667 | 2007-02-01 | 2012-11-16 | 200 1ST AVE, #305, ST PETE BEACH, FL, 337064364, US | 3321 49TH ST N, ST PETERSBURG, FL, 337102145, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 727-744-4880 |
| Fax | 7273674139 |
| Phone | +1 727-743-9060 |
Authorized person
| Name | JOAN S MASON |
| Role | OWNER |
| Phone | 7277439060 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | SW4600 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 7940163 |
| State | FL |
| Issuer | MEDICARE SENDER/SUBMITTER |
| Number | P4510 |
| State | FL |
| Issuer | MEDICARE PROVIDER ID 1538207667 |
| Number | 1538207667 |
| State | FL |
| Issuer | MAGELLAN |
| Number | 182234000 |
| State | FL |
| Issuer | MEDICARE GROUP PTAN |
| Number | AK104 |
| State | FL |
| Issuer | HUMANA |
| Number | 4014110 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | Z8210Z |
| State | FL |
| Issuer | CIGNA |
| Number | 0739204 |
| State | FL |
| Issuer | UNITED BEHAVIORAL HEALTH |
| Number | 512778450 |
| Name | Role | Address |
|---|---|---|
| MASON JOAN S | Agent | 200 1ST AVE, PASS-A-GRILLE, FL, 33706 |
| Name | Role | Address |
|---|---|---|
| MASON JOAN S | Director | 200 1ST AVE # 305, PASS-A-GRILLE, FL, 33706 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2001-04-27 | 200 1ST AVE, 305, PASS-A-GRILLE, FL 33706 | No data |
| CHANGE OF MAILING ADDRESS | 2001-04-27 | 200 1ST AVE, 305, PASS-A-GRILLE, FL 33706 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2001-04-27 | 200 1ST AVE, 305, PASS-A-GRILLE, FL 33706 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-03-17 |
| ANNUAL REPORT | 2017-03-17 |
| ANNUAL REPORT | 2016-03-25 |
| ANNUAL REPORT | 2015-02-25 |
| ANNUAL REPORT | 2014-03-28 |
| ANNUAL REPORT | 2013-04-24 |
| ANNUAL REPORT | 2012-04-02 |
| ANNUAL REPORT | 2011-02-17 |
| ANNUAL REPORT | 2010-02-18 |
| ANNUAL REPORT | 2009-04-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
