Provider Demographics
NPI:1184807620
Name:MASLINE, SEBENA L (IWSC)
Entity type:Individual
Prefix:MS
First Name:SEBENA
Middle Name:L
Last Name:MASLINE
Suffix:
Gender:F
Credentials:IWSC
Other - Prefix:
Other - First Name:MASLINE
Other - Middle Name:SUPPORT
Other - Last Name:SERVICES, INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9155
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-0155
Mailing Address - Country:US
Mailing Address - Phone:904-764-7161
Mailing Address - Fax:888-875-4930
Practice Address - Street 1:435 CLARK RD
Practice Address - Street 2:SUITE 310
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5596
Practice Address - Country:US
Practice Address - Phone:904-764-7161
Practice Address - Fax:888-875-4930
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator