Provider Demographics
NPI:1649508482
Name:MACEDO, ELIZABETH MARIE (MFT)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:MACEDO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 MARCO POLO WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4503
Mailing Address - Country:US
Mailing Address - Phone:650-259-8544
Mailing Address - Fax:650-259-0188
Practice Address - Street 1:1764 MARCO POLO WAY
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4503
Practice Address - Country:US
Practice Address - Phone:650-259-8544
Practice Address - Fax:650-259-0188
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47815106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1AVOtherMEDICAL