Mastellone, Max
Mastellone, Max is an sole proprietor health care provider with primary practice located at 330 N Campo St , Las Cruces NM 88001-3433. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Mastellone, Max can be contacted via phone (609) 706-5931.Contact Information
Primary practice address
330 N Campo St
Las Cruces NM 88001-3433
Phone: (609) 706-5931
Fax: (505) 521-6259
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 0953 | New Mexico |
| Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities | 103TM1800X | 0953 | New Mexico |
Profile Details
| NPI number | 1134278179 |
|---|---|
| LBN Legal business name | Mastellone, Max |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 9th, 2007 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134278179 | NPPES |
| New Mexico | MEDICAID | 39980847 | |
| New Mexico | MEDICAID | 22559302 |
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