Organization
MASINO THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE PETER MASINO II PSY.D. (PRESIDENT)
(850) 797-6060
Entity
Organization
Contact information
Practice address
1008 AIRPORT RD, DESTIN, FL 32541-2823
(850) 424-5210
(850) 424-3220
Mailing address
1008 AIRPORT RD, SUITE D, DESTIN, FL 32541-2823
(850) 424-5210
(850) 424-3220
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
PY6559
FL
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
PY6920
FL
Other
Enumeration date
07/01/2009
Last updated
03/02/2012
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