Provider Demographics
NPI:1619013471
Name:MACER, JEMELA SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEMELA
Middle Name:SUE
Last Name:MACER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N MARYLAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4270
Mailing Address - Country:US
Mailing Address - Phone:818-242-5460
Mailing Address - Fax:818-790-4126
Practice Address - Street 1:116 N MARYLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4270
Practice Address - Country:US
Practice Address - Phone:818-242-5460
Practice Address - Fax:818-790-4126
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12504103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist