MEDICARE: MARY STEPHANIE MACANCELA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		NY

General Provider Information

NPI Number	:	1154278380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY STEPHANIE MACANCELA

Provider Business Mailing Address
First Line	:	9109 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7995
Country	:	US
Telephone Number	:	718-908-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9109 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7995
Country	:	US
Telephone Number	:	718-908-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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