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NPI Code Detail

MEDICARE: DR. MAX MASTELLONE PH.D.

MEDICARE: DR. MAX MASTELLONE PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist0953NM
2103TM1800XIntellectual & Developmental Disabilities Psychologist0953NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134278179
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAX MASTELLONE PH.D.
Provider Business Mailing Address
First Line : 2615 CASHMERE CT
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-0800
Country : US
Telephone Number : 609-706-5931
Fax Number : 505-521-6259
Provider Business Practice Location Address
First Line : 330 N CAMPO ST
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-3433
Country : US
Telephone Number : 609-706-5931
Fax Number : 505-521-6259
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 09/11/2025

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Directions to “ DR. MAX MASTELLONE PH.D.” Practice Location

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