Provider Demographics
NPI:1962654152
Name:CHRISTODOULOU- MACFIE, MARINA (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:CHRISTODOULOU- MACFIE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7158 AUSTIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4732
Mailing Address - Country:US
Mailing Address - Phone:347-885-2712
Mailing Address - Fax:
Practice Address - Street 1:7158 AUSTIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4732
Practice Address - Country:US
Practice Address - Phone:347-885-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-0773021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical