Provider Demographics
NPI:1013276013
Name:MARGARET A. MACDEVITT PH.D, PC
Entity Type:Organization
Organization Name:MARGARET A. MACDEVITT PH.D, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOLEPROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACDEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:906-226-9584
Mailing Address - Street 1:123 E ARCH ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3801
Mailing Address - Country:US
Mailing Address - Phone:906-226-9584
Mailing Address - Fax:906-228-8057
Practice Address - Street 1:123 E ARCH ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3801
Practice Address - Country:US
Practice Address - Phone:906-226-9584
Practice Address - Fax:906-228-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005893103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE245100Medicare PIN