Provider Demographics
NPI:1750930210
Name:MACHARDY, MARYKATE
Entity type:Individual
Prefix:
First Name:MARYKATE
Middle Name:
Last Name:MACHARDY
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 1:133 SUTTON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1450
Mailing Address - Country:US
Mailing Address - Phone:802-236-5496
Mailing Address - Fax:
Practice Address - Street 1:133 SUTTON ST APT 1
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1450
Practice Address - Country:US
Practice Address - Phone:802-236-5496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor