Individual
MACY KAITLYN MINNOCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
734 10TH AVE, SAN DIEGO, CA 92101-6502
(619) 239-4663
(619) 239-3045
Mailing address
11545 WINDCREST LN APT 193, SAN DIEGO, CA 92128-4241
(408) 594-8686
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
40624
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/29/2018
Last updated
10/09/2025
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