Healthcare Provider Details

I. General information

NPI: 1003240235
Provider Name (Legal Business Name): MACY PSYCHOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7676 HAZARD CENTER DR STE 500
SAN DIEGO CA
92108-4508
US

IV. Provider business mailing address

7676 HAZARD CENTER DR STE 500
SAN DIEGO CA
92108-4508
US

V. Phone/Fax

Practice location:
  • Phone: 619-876-8261
  • Fax:
Mailing address:
  • Phone: 619-876-8261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPSY 20536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberPSY 20536
License Number StateCA

VIII. Authorized Official

Name: DR. BRANDY DIANE MACY
Title or Position: PRESIDENT AND CEO
Credential: PSY.D.
Phone: 619-876-8261