Provider Demographics
NPI:1205138914
Name:DE MASSIMO, JOSEPH BLAKE
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BLAKE
Last Name:DE MASSIMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 JUDSON ST
Mailing Address - Street 2:APT. 130
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4020
Mailing Address - Country:US
Mailing Address - Phone:619-318-2343
Mailing Address - Fax:
Practice Address - Street 1:755 JUDSON ST
Practice Address - Street 2:APT. 130
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4020
Practice Address - Country:US
Practice Address - Phone:619-318-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor