Provider Demographics
NPI:1053703298
Name:CATHRYNE L. MACIOLEK, PSY.D., LLC
Entity type:Organization
Organization Name:CATHRYNE L. MACIOLEK, PSY.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHRYNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACIOLEK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-591-5380
Mailing Address - Street 1:540 E BELVEDERE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3750
Mailing Address - Country:US
Mailing Address - Phone:410-591-5380
Mailing Address - Fax:
Practice Address - Street 1:540 E. BELVEDERE AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212
Practice Address - Country:US
Practice Address - Phone:410-591-5380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
393635OtherMEDICARE PTAN