Provider Demographics
NPI:1417964974
Name:MACINTYRE, ERIN PAIGE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:PAIGE
Last Name:MACINTYRE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SUBURBAN ROAD
Mailing Address - Street 2:SUITE A 1
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7534
Mailing Address - Country:US
Mailing Address - Phone:805-441-3130
Mailing Address - Fax:
Practice Address - Street 1:200 SUBURBAN ROAD
Practice Address - Street 2:SUITE A 1
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7534
Practice Address - Country:US
Practice Address - Phone:805-441-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20839103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical