Provider Demographics
NPI:1942376983
Name:MASCHI, MICHAEL BRUNO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRUNO
Last Name:MASCHI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 STERLING LN
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-1816
Mailing Address - Country:US
Mailing Address - Phone:609-698-2027
Mailing Address - Fax:
Practice Address - Street 1:2421 ATLANTIC AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1000
Practice Address - Country:US
Practice Address - Phone:732-528-5334
Practice Address - Fax:732-528-5279
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051913001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086645RX7Medicare ID - Type Unspecified