Basic Information
| Provider Information | |||||||||
| NPI: | 1417449687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACEK | ||||||||
| FirstName: | CAROL | ||||||||
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| Credential: | CT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6753 STATE RD | ||||||||
| Address2: | |||||||||
| City: | PARMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441344517 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7800 DETROIT AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441022814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2166347500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2018 | ||||||||
| LastUpdateDate: | 06/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | C.1800932-TRNE | OH | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.