DR. MARY LOU MACILVAINE (NPI# 1083879506) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083879506 |
| Entity Type | Individual |
| Full Name | DR. MARY LOU MACILVAINE |
| Other Name | DR. MARY LOUISE MACILVAINE |
| Credential | PH.D. |
| Practice Address |
4313 Ridgeway Dr San Diego CA 92116-2052 |
| Practice Telephone | 6195010334 |
| Mailing Telephone | 6195010334 |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2008-07-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
14409 | CA | Behavioral Health & Social Service Providers |
| N | 103TH0004X |
Psychologist Specialization: Health |
14409 | CA | Behavioral Health & Social Service Providers |
| Street Address |
4313 RIDGEWAY DR |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92116-2052 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255859450 | Michael S Cohen | Acupuncturist | 1533 Monroe Ave, San Diego, CA 92116 | 2017-09-07 |
| 1013456052 | Scarlett O'hara | Speech-Language Pathologist | 4204a Adams Avenue, San Diego, CA 92116 | 2017-02-22 |
| 1780123174 | Elaine Oxina | Occupational Therapist | 4204 Adams Avenue A, Specialized Therapy Services, San Diego, CA 92116 | 2017-02-17 |
| 1699157321 | Candice Dumais | Occupational Therapist | 4522 1/2 Georgia St, San Diego, CA 92116 | 2015-06-18 |
| 1558643908 | Markus Steven Hill | Student in an Organized Health Care Education/Training Program | 4489 41st St, San Diego, CA 92116 | 2011-09-12 |
| 1457689309 | Nirit Shoshana Blocker | Physical Therapist | 4663 Iowa St Unit 5, San Diego, CA 92116 | 2009-12-03 |
| 1780830257 | Latrice Charlene Washington | Counselor | 3430 School St, San Diego, CA 92116 | 2008-08-15 |
| 1497901086 | Kathryn Eris Zangaro | Counselor | 3430 School St., San Diego, CA 92116 | 2008-08-14 |
| 1508012535 | Cyrus Satoafaiga | Counselor | 3430 School Street, San Diego, CA 92116 | 2008-08-11 |
| 1164692471 | Kimberly Hoover L.ac. | Acupuncturist | 2852 Adams Avenue, San Diego, CA 92116 | 2008-03-04 |
| Find all providers in zip 92116 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730711375 | Benjamin Alpert, Psyd, A Psychological Corporation | Psychologist | 2525 Camino Del Rio S Ste 305 Office2, San Diego, CA 92108-3717 | 2020-02-11 |
| 1134787815 | Kyline Sky Bellotti | Psychologist | 5025 Collwood Blvd # 3316, San Diego, CA 92115-2126 | 2019-05-29 |
| 1376007815 | San Diego Kids First | Psychologist | 12625 High Bluff Dr Ste 111, San Diego, CA 92130-2053 | 2019-01-29 |
| 1346628179 | Orchid Healthcare Inc | Psychologist | 15373 Innovation Drive, Ste 395, San Diego, CA 92128-3429 | 2015-05-13 |
| 1417394669 | Eliana Hurwich-reiss | Psychologist | 3665 Kearny Villa Rd Ste 200, San Diego, CA 92123-1954 | 2013-05-29 |
| 1548517287 | Jamie Lynn Young | Psychologist | 11665 Avena Pl Ste 204, San Diego, CA 92128-2428 | 2012-08-13 |
| 1063733707 | Kristen J Peairs | Psychologist | 1224 Bush St, San Diego, CA 92103-2809 | 2010-06-16 |
| 1265661714 | Lauren Brookman-frazee | Psychologist | 3020 Children's Way (mc 5033), San Diego, CA 92123 | 2009-07-06 |
| 1144330382 | Mary J Baker-ericzen | Psychologist | 3990 Old Town Ave Ste A207, San Diego, CA 92110-2967 | 2006-08-30 |
| 1720003056 | Miranda B Williams | Psychologist | 7290 Navajo Rd Ste 105, San Diego, CA 92119 | 2006-07-13 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.