Provider Demographics
NPI:1306830120
Name:MASINO, JENNIFER JUNE SILLENCE (PSY D)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JUNE SILLENCE
Last Name:MASINO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:JUNE
Other - Last Name:SILLENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:120 SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-5400
Mailing Address - Country:US
Mailing Address - Phone:850-884-5571
Mailing Address - Fax:
Practice Address - Street 1:120 SIMPSON AVE
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5400
Practice Address - Country:US
Practice Address - Phone:850-884-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical