Physician Compare National (NPI:1700811015)

HEALTHCARE PROVIDER: MARY LYNNE MACK PHD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1700811015
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0244240950
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20060426000115
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MACK
	Individual professional last name
Provider First Name	MARY
	Individual professional first name
Provider Middle Name	LYNNE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	CP
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2003
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	20700 WATERTOWN RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 240
	Group Practice or individual's line 2 address
City	WAUKESHA
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	531861800
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M