Provider Demographics
NPI:1760441794
Name:MACCARIN, JULIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:MACCARIN
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 1:106 TREANOR ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3819
Mailing Address - Country:US
Mailing Address - Phone:415-325-4453
Mailing Address - Fax:828-225-9888
Practice Address - Street 1:45 SAN CLEMENTE DRIVE
Practice Address - Street 2:SUITE D220
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1244
Practice Address - Country:US
Practice Address - Phone:415-325-4453
Practice Address - Fax:828-225-9888
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4694225XP0200X
NC2751103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000256Medicaid