MEDICARE: NICHOLAS MICHAEL MACCONE MPSY

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	103T00000X	Psychologist	8764	PR

General Provider Information

NPI Number	:	1952260390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS MICHAEL MACCONE MPSY

Provider Business Mailing Address
First Line	:	URB. TERRAZA DEL MONTE CALLE PINO 63
Second Line	:
City	:	LAS PIEDRAS
State	:	PR
Zip	:	00771-0000
Country	:	US
Telephone Number	:	787-562-9346
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB. GOLDEN HILL CALLE ANCIETO A5
Second Line	:
City	:	TRUJILLO ALTO
State	:	PR
Zip	:	00976-0000
Country	:	US
Telephone Number	:	787-562-9346
Fax Number	:

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

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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