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General NPI Number Information
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NPI Number | 1144214792
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Entity Type | Individual
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Provider Name | THEODORE PETER MASINO II PSY. D.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 507 JOHN SIMS PKWY E
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City | NICEVILLE
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State | FL
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Zip | 32578-2027
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Country | US
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Telephone | 850-424-5210
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Fax | 850-424-3220
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Provider Business Mailing Address
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Address Line | 507 JOHN SIMS PKWY E
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City | NICEVILLE
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State | FL
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Zip | 32578-2027
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Country | US
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Telephone | 850-424-5210
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Fax | 850-424-3220
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6920
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License Number State | FL
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