Provider Demographics
NPI:1770784829
Name:MACKE, PAUL BERNARD (MA DMIN)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BERNARD
Last Name:MACKE
Suffix:
Gender:M
Credentials:MA DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 NEW HAMPSHIRE AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2526
Mailing Address - Country:US
Mailing Address - Phone:202-939-1727
Mailing Address - Fax:202-328-9212
Practice Address - Street 1:1616 P ST NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1434
Practice Address - Country:US
Practice Address - Phone:202-462-0400
Practice Address - Fax:202-328-9212
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral