Provider Demographics
NPI:1689815235
Name:MACIOLEK WAUGH, CATHRYNE LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CATHRYNE
Middle Name:LYNN
Last Name:MACIOLEK WAUGH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CATHRYNE
Other - Middle Name:L
Other - Last Name:MACIOLEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:200 E JOPPA RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3150
Mailing Address - Country:US
Mailing Address - Phone:410-591-5380
Mailing Address - Fax:
Practice Address - Street 1:1400 FRONT AVE STE 305
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5364
Practice Address - Country:US
Practice Address - Phone:410-591-5380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD336569700Medicaid
261610ZDB6Medicare PIN