Provider Demographics
NPI:1063699023
Name:TAYLOR, MERY MACALUSO (PHD)
Entity type:Individual
Prefix:DR
First Name:MERY
Middle Name:MACALUSO
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MERY
Other - Middle Name:JESSY
Other - Last Name:MACALUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:CHOC PEDIATRIC PSYCHOLOGY DEPT.
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3835
Mailing Address - Country:US
Mailing Address - Phone:714-532-8481
Mailing Address - Fax:714-532-8756
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:CHOC PEDIATRIC PSYCHOLOGY DEPT.
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3835
Practice Address - Country:US
Practice Address - Phone:714-532-8481
Practice Address - Fax:714-532-8756
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21828103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent