MEDICARE: MONA MACKSOUD PHD

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	103TC0700X	Clinical Psychologist	011342	NY

General Provider Information

NPI Number	:	1174489066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONA MACKSOUD PHD

Provider Business Mailing Address
First Line	:	875 FENIMORE RD
Second Line	:
City	:	LARCHMONT
State	:	NY
Zip	:	10538-1010
Country	:	US
Telephone Number	:	914-834-0709
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 FENIMORE RD
Second Line	:
City	:	LARCHMONT
State	:	NY
Zip	:	10538-1010
Country	:	US
Telephone Number	:	914-834-0709
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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