Provider Demographics
NPI:1215531694
Name:MACCHIA, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MACCHIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 NE ELDERBERRY TER
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4655
Mailing Address - Country:US
Mailing Address - Phone:772-475-0815
Mailing Address - Fax:
Practice Address - Street 1:10636 3RD ST N APT K
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3291
Practice Address - Country:US
Practice Address - Phone:772-475-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-141071106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108455300Medicaid