Provider Demographics
NPI:1427391440
Name:MACURA, JOSEPH MATTHEW
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MATTHEW
Last Name:MACURA
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 1:162 N MAIN ST STE 5
Mailing Address - Street 2:STONEY BROOK PLAZA
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3024
Mailing Address - Country:US
Mailing Address - Phone:866-639-9573
Mailing Address - Fax:
Practice Address - Street 1:162 N MAIN ST STE 5
Practice Address - Street 2:STONEY BROOK PLAZA
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3024
Practice Address - Country:US
Practice Address - Phone:866-639-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health