Provider Demographics
NPI:1255746764
Name:MACIK, MARY
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:
Last Name:MACIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OLD POND RD # R
Mailing Address - Street 2:702
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-3415
Mailing Address - Country:US
Mailing Address - Phone:412-221-7770
Mailing Address - Fax:412-221-7773
Practice Address - Street 1:800 OLD POND RD # R
Practice Address - Street 2:702
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-3415
Practice Address - Country:US
Practice Address - Phone:412-221-7770
Practice Address - Fax:412-221-7773
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional