Provider Demographics
NPI:1437440211
Name:MACEDO, JOSEPH NICK (CAADC II)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:NICK
Last Name:MACEDO
Suffix:
Gender:M
Credentials:CAADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ALLERTON ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1519
Mailing Address - Country:US
Mailing Address - Phone:650-599-9955
Mailing Address - Fax:650-599-9273
Practice Address - Street 1:500 ALLERTON ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1519
Practice Address - Country:US
Practice Address - Phone:650-599-9955
Practice Address - Fax:650-599-9273
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3360109101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3360109OtherCALIFORNIA ASSOCIATION ALCOHOLISM AND DRUG ABUSE COUNSELORS