| Doctor Name: | MISS MARY MACIK |
| NPI Number: | 1255746764 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | PC005315 |
| Business Practice Address: | 800 Old Pond Rd # R 702 Bridgeville, PA - 150173415 |
| Business Phone Number: | 4122217770 |
| Business Fax Number: | 4122217773 |
| Mailing Address: | 800 Old Pond Rd # R, 702 BRIDGEVILLE |
| State: | PA |
| Postal Code: | 150173415 |
| Phone Number: | 4122217770 |
| Fax Number: | 4122217773 |
| NPI Enumeration Date: | 06/23/2014 |
| NPI Last Update Date: | 06/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | PC005315 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |