Individual
DR. MARYBETH MACKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
497 BROADWAY, ROOM 2, BAYONNE, NJ 07002
(201) 437-4200
Mailing address
497 BROADWAY, ROOM 2, BAYONNE, NJ 07002
(201) 437-4200
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
10858
NY
103TC0700X
Clinical Psychologist
Primary
3214
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10858
NY LICENSE
—
01
—
3214
NJ LICENSE
—
Enumeration date
10/31/2006
Last updated
07/08/2007
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