Provider Demographics
NPI:1376641597
Name:MACLEAY, KATHY JEAN (PHD)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:JEAN
Last Name:MACLEAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13210 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4844
Mailing Address - Country:US
Mailing Address - Phone:818-365-9092
Mailing Address - Fax:818-365-0195
Practice Address - Street 1:13210 HARDING ST
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4844
Practice Address - Country:US
Practice Address - Phone:818-365-9092
Practice Address - Fax:818-332-1877
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12688103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY126881Medicaid