Dr. Mary Lou Macilvaine
Health Psychologist Clinical Child & Adolescent Psychologist
4313 Ridgeway Dr
San Diego
, California 92116-2052
Dr. Mary Lou Macilvaine
Health Psychologist Clinical Child & Adolescent Psychologist
4313 Ridgeway Dr
San Diego
, California 92116-2052
(619) 501-0334
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About
Features
Specialties
- Clinical Child & Adolescent Psychologist
- Health Psychologist
Languages spoken
- English
Location
First Address
- Dr. Mary Lou Macilvaine
- 4313 Ridgeway Dr
- San Diego, CA
- Zip : 92116-2052
- Phone : (619) 501-0334
Second Address
- Dr. Mary Lou Macilvaine
- 4313 Ridgeway Dr
- San Diego, CA
- Zip : 92116-2052
- Phone : (619) 501-0334
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 14409 | CA |
| N | 103TH0004X | Health Psychologist | 14409 | CA |
National Provider Identifier
| NPI | 1083879506 |
|---|---|
| Provider Name | Dr. Mary Lou Macilvaine |
| First Address | San Diego, CA 92116-2052 |
| Second Address | San Diego, CA 92116-2052 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/07/2008 |
| Last Update Date | 24/07/2008 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.