Provider Demographics
NPI:1508977216
Name:MACAULAY, ANDREA (PSYD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MACAULAY
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 1:4 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-1243
Mailing Address - Country:US
Mailing Address - Phone:508-287-8633
Mailing Address - Fax:
Practice Address - Street 1:261 UNION ST UNIT 218
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5949
Practice Address - Country:US
Practice Address - Phone:508-996-2390
Practice Address - Fax:508-996-2524
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7392103G00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent