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General NPI Number Information
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NPI Number | 1760609259
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Entity Type | Organization
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Legal Business Name | JOSHUA M. MASINO, PSY.D., LLC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1071 CAMBRIDGE SQ SUITE E
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City | ALPHARETTA
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State | GA
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Zip | 30004-1843
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Country | US
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Telephone | 404-242-8188
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Fax | 378-393-8637
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Provider Business Mailing Address
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Address Line | 1071 CAMBRIDGE SQ SUITE E
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City | ALPHARETTA
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State | GA
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Zip | 30004-1843
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Country | US
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Telephone | 404-242-8188
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Fax | 378-393-8637
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSHUA MYLES MASINO
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Credential | PSY.D.
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Telephone | 404-242-8188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 003043
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License Number State | GA
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