1144214792 NPI number — DR. THEODORE PETER MASINO II PSY. D.

Table of content: DR. THEODORE PETER MASINO II PSY. D. (NPI 1144214792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144214792 NPI number — DR. THEODORE PETER MASINO II PSY. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASINO
Provider First Name:
THEODORE
Provider Middle Name:
PETER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
PSY. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144214792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
507 JOHN SIMS PKWY E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NICEVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32578-2027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-424-5210
Provider Business Mailing Address Fax Number:
850-424-3220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 JOHN SIMS PKWY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NICEVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32578-2027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-424-5210
Provider Business Practice Location Address Fax Number:
850-424-3220
Provider Enumeration Date:
09/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY6920 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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