Provider Demographics
NPI:1447586862
Name:MACEDONIO, MARY F (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:F
Last Name:MACEDONIO
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:22907 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2412
Mailing Address - Country:US
Mailing Address - Phone:718-380-2202
Mailing Address - Fax:800-881-4115
Practice Address - Street 1:22907 64TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2412
Practice Address - Country:US
Practice Address - Phone:718-380-2202
Practice Address - Fax:800-881-4115
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018162-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist