Healthcare Provider Details

I. General information

NPI: 1437390473
Provider Name (Legal Business Name): SUSAN ELIZABETH MACNAMARA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2009
Last Update Date: 03/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 ONEIDA ST
SALT LAKE CITY UT
84109-1527
US

IV. Provider business mailing address

2340 ONEIDA ST
SALT LAKE CITY UT
84109-1527
US

V. Phone/Fax

Practice location:
  • Phone: 801-910-4644
  • Fax:
Mailing address:
  • Phone: 801-910-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number113841-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: