MEDICARE: MARY JURATE MACYS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0983	KY
2	103TH0100X	Health Service Psychologist	0983	KY

General Provider Information

NPI Number	:	1588648216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JURATE MACYS PHD

Provider Business Mailing Address
First Line	:	8139 NEW LAGRANGE RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-4682
Country	:	US
Telephone Number	:	502-423-9509
Fax Number	:	502-423-9501

Provider Business Practice Location Address
First Line	:	8139 NEW LAGRANGE RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-4682
Country	:	US
Telephone Number	:	502-423-9509
Fax Number	:	502-423-9501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/15/2010

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