Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0983 | KY |
Y | 103TC0700X | Clinical Psychologist | 0983 | KY |
N | 103TH0100X | Health Service | 0983 | KY |
NPI | 1588648216 |
---|---|
Provider Name | Mary Jurate Macys |
First Address | Louisville, KY 40222-4682 |
Second Address | Louisville, KY 40222-4682 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 15/07/2010 |