Provider Demographics
NPI:1588392468
Name:SAM MACY PSYD PLLC
Entity type:Organization
Organization Name:SAM MACY PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MACY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-655-0386
Mailing Address - Street 1:3517 W WRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1248
Mailing Address - Country:US
Mailing Address - Phone:773-655-0386
Mailing Address - Fax:
Practice Address - Street 1:3517 W WRIGHTWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1248
Practice Address - Country:US
Practice Address - Phone:773-655-0386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty