=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154434280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. CHRISTINE MAKARY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 251CAUSEWAY ST
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-248-1075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 ARBELLA ST
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01970-3913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 759
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------