Healthcare Provider Details

I. General information

NPI: 1528083961
Provider Name (Legal Business Name): NICHOLAS MICHAEL MACCARRONE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 AVENTURA BLVD STE 300
AVENTURA FL
33180-3109
US

IV. Provider business mailing address

2925 AVENTURA BLVD STE 300
AVENTURA FL
33180-3109
US

V. Phone/Fax

Practice location:
  • Phone: 305-936-1002
  • Fax: 305-936-1022
Mailing address:
  • Phone: 954-461-6276
  • Fax: 954-697-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: