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General NPI Number Information
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NPI Number | 1003240235
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Entity Type | Organization
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Legal Business Name | MACY PSYCHOLOGY, INC
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 7676 HAZARD CENTER DR STE 500
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City | SAN DIEGO
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State | CA
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Zip | 92108-4508
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Country | US
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Telephone | 619-876-8261
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Fax |
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Provider Business Mailing Address
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Address Line | 7676 HAZARD CENTER DR STE 500
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City | SAN DIEGO
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State | CA
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Zip | 92108-4508
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Country | US
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Telephone | 619-876-8261
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. BRANDY DIANE MACY
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Credential | PSY.D.
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Telephone | 619-876-8261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | PSY 20536
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY 20536
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License Number State | CA
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