Provider Demographics
NPI:1285410522
Name:MACCARRONE, JODIE (PHD)
Entity type:Individual
Prefix:DR
First Name:JODIE
Middle Name:
Last Name:MACCARRONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 W BOYNTON BEACH BLVD # 310
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3526
Mailing Address - Country:US
Mailing Address - Phone:561-809-4052
Mailing Address - Fax:
Practice Address - Street 1:550 SE 6TH AVE # 200
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5306
Practice Address - Country:US
Practice Address - Phone:561-794-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11996103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty