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General NPI Number Information
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NPI Number | 1396671608
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Entity Type | Organization
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Legal Business Name | MARA MAKASIAR, PHD, PLLC
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Dates
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Enumeration Date | 06/23/2026
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Last Update Date | 06/23/2026
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Provider Practice Location Address
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Address Line | 2401 ALDRICH ST APT 412
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City | AUSTIN
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State | TX
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Zip | 78723-2123
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Country | US
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Telephone | 512-609-0729
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 ALDRICH ST APT 412
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City | AUSTIN
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State | TX
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Zip | 78723-2123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | MARIE MARANATHA MAKASIAR
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Credential | PHD
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Telephone | 630-258-9991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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