Provider Demographics
NPI:1578370243
Name:DE MASSE, JUDE JEROME
Entity type:Individual
Prefix:
First Name:JUDE
Middle Name:JEROME
Last Name:DE MASSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 MANDOLIN CT
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3630
Mailing Address - Country:US
Mailing Address - Phone:646-852-8213
Mailing Address - Fax:
Practice Address - Street 1:4975 MANDOLIN CT
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3630
Practice Address - Country:US
Practice Address - Phone:646-852-8213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist