Provider Demographics
NPI:1346468923
Name:MAASKE, JON (PHD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:MAASKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CARLISLE BLVD NE
Mailing Address - Street 2:SUITE 227
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1600
Mailing Address - Country:US
Mailing Address - Phone:505-889-4570
Mailing Address - Fax:
Practice Address - Street 1:3200 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 227
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1600
Practice Address - Country:US
Practice Address - Phone:505-889-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-21
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM498103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis