Provider Demographics
NPI:1548586829
Name:MACEACHRON, PHILIP TODD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:TODD
Last Name:MACEACHRON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NEVIN AVE
Mailing Address - Street 2:KAISER PERMANENTE DEPT. OF PSYCHIATRY
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3143
Mailing Address - Country:US
Mailing Address - Phone:510-307-1667
Mailing Address - Fax:510-307-1615
Practice Address - Street 1:901 NEVIN AVE
Practice Address - Street 2:KAISER PERMANENTE DEPT. OF PSYCHIATRY
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3143
Practice Address - Country:US
Practice Address - Phone:510-307-1667
Practice Address - Fax:510-307-1615
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22427103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical