Healthcare Provider Details

I. General information

NPI: 1760441794
Provider Name (Legal Business Name): JULIE MACCARIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SAN CLEMENTE DRIVE SUITE D220
CORTE MADERA CA
94925-1244
US

IV. Provider business mailing address

106 TREANOR ST
SAN RAFAEL CA
94901-3819
US

V. Phone/Fax

Practice location:
  • Phone: 415-325-4453
  • Fax: 828-225-9888
Mailing address:
  • Phone: 415-325-4453
  • Fax: 828-225-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2751
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4694
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: