Provider Demographics
NPI:1053336719
Name:MCMACHEN, MARY JOY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOY
Last Name:MCMACHEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6492 PEMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7760
Mailing Address - Country:US
Mailing Address - Phone:734-595-8077
Mailing Address - Fax:845-230-3285
Practice Address - Street 1:6492 PEMBROOK DR
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7760
Practice Address - Country:US
Practice Address - Phone:734-595-8077
Practice Address - Fax:845-230-3285
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680H24746OtherBLUE CROSS BLUE SHIELD
MI680H24746OtherBLUE CROSS BLUE SHIELD