Provider Demographics
NPI:1518647395
Name:MASINO, MAX (MS)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:MASINO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 MAIN ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1600
Mailing Address - Country:US
Mailing Address - Phone:215-378-3137
Mailing Address - Fax:
Practice Address - Street 1:1077 RYDAL RD STE 107
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1712
Practice Address - Country:US
Practice Address - Phone:267-669-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health