Individual
JULIE M MACK
Active
Individual
JULIE M MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD PSYCHOLOGY
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
3769
MA
103TB0200X
Cognitive & Behavioral Psychologist
B769
MA
103TC0700X
Clinical Psychologist
Primary
3679
MA
103TF0200X
Forensic Psychologist
3769
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000821
VALUE OPTIONS
—
01
—
009484
TRICARE
—
05
—
0515299
—
MA
01
—
1007070
BEACON HEALTH
—
01
—
111631000
MAGELLAN
—
01
—
202886
MHN
—
01
—
3249700821
HARVARD PILGRIM
—
01
—
4545006
AETNA
—
01
—
6151458
UNITED
—
01
—
703727
1ST HEALTH
—
01
—
767861
TUFTS
—
01
—
M62937
1ST SENIORITY
—
Enumeration date
11/28/2006
Last updated
09/29/2011
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