Provider Demographics
NPI:1093540197
Name:MACMATH, MARCIA ELLEN (LMHC)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ELLEN
Last Name:MACMATH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 31ST ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7605
Mailing Address - Country:US
Mailing Address - Phone:727-821-4819
Mailing Address - Fax:
Practice Address - Street 1:445 31ST ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7605
Practice Address - Country:US
Practice Address - Phone:727-821-4819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health