Provider Demographics
NPI:1437715174
Name:MACARI, JOHN ANGELO
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANGELO
Last Name:MACARI
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 1:2485 CARRIAGE CT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-7429
Mailing Address - Country:US
Mailing Address - Phone:734-972-7747
Mailing Address - Fax:
Practice Address - Street 1:1 HERITAGE DR STE 520
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3051
Practice Address - Country:US
Practice Address - Phone:800-963-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361002356103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist