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General NPI Number Information
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NPI Number | 1578789012
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Entity Type | Individual
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Provider Name | CHRISTINE MARY MACHLICA LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 66 HAVRID RD
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City | COMMACK
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State | NY
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Zip | 11725
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Country | US
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Telephone | 516-313-3397
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Fax | 516-543-8573
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Provider Business Mailing Address
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Address Line | 43 ASHLAND DR
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City | KINGS PARK
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State | NY
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Zip | 11754
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Country | US
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Telephone | 631-366-0469
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Fax | 631-543-8573
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | R0500301
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License Number State | NY
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