Mary Lou Macilvaine in San Diego - Clinical Child & Adolescent
Mary Lou Macilvaine - NPI 1083879506
Mary Lou Macilvaine is a Clinical Child & Adolescent in San Diego, California. Mary Lou Macilvaine practices all healthcare services and medical treatments related to Clinical Child & Adolescent. The NPI Number for Mary Lou Macilvaine is 1083879506. The last update date is 2008-07-24.
Mary Lou Macilvaine's current location address is 4313 Ridgeway Dr, San Diego, California. You can contact this provider via phone number 6195010334. The mailing address for Mary Lou Macilvaine is 4313 Ridgeway Dr, San Diego, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Mary Lou Macilvaine |
|---|---|
| Address | 4313 Ridgeway Dr, San Diego, California |
| Phone Number | 6195010334 |
| Fax Number | |
| Sole Proprietor | Y |
| Credentials | PH.D. |
NPI Number Detail
| NPI Number | 1083879506 |
|---|---|
| Provider Enumeration Date | 2008-07-24 |
| Last Updated Date | 2008-07-24 |
Provider Mailing Address Detail
| Address | 4313 Ridgeway Dr |
|---|---|
| City | San Diego |
| State | California (CA) |
| Post Code | 921162052 |
| Phone Number | 6195010334 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Clinical Child & Adolescent |
|---|---|
| Taxonomy | 103Tc2200X |
| Licence No | 14409 |
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Definition: A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology |
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What is the Mary Lou Macilvaine's 1083879506?
The Mary Lou Macilvaine's NPI (National Provider Identifier) Number is 1083879506. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of Mary Lou Macilvaine?
The Mary Lou Macilvaine is situated at 4313 Ridgeway Dr, in the city of San Diego, state of CA, with the zip code 921162052.
What is the Mary Lou Macilvaine's area of specialization and corresponding taxonomy classification?
The Mary Lou Macilvaine's specialty field is Clinical Child & Adolescent, and it falls under the taxonomy code 103Tc2200X, which categorizes healthcare providers based on their specialties.
On what date did the Centers for Medicare & Medicaid Services issue the 1083879506 to Mary Lou Macilvaine?
The Mary Lou Macilvaine received its 1083879506 assignment from the Centers for Medicare & Medicaid Services on 2008-07-24.
When was the Mary Lou Macilvaine's information last updated?
The Mary Lou Macilvaine's information was last updated on 2008-07-24.