Provider Demographics
NPI:1942830153
Name:MASCHKE, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MASCHKE
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 1:6351 SW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4840
Mailing Address - Country:US
Mailing Address - Phone:786-514-8965
Mailing Address - Fax:
Practice Address - Street 1:1550 MADRUGA AVE STE 334
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3094
Practice Address - Country:US
Practice Address - Phone:786-514-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health