Provider Demographics
NPI:1588702153
Name:MACCHI, CR (PHD)
Entity type:Individual
Prefix:
First Name:CR
Middle Name:
Last Name:MACCHI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N. 3RD STREET MAIL CODE 3320
Mailing Address - Street 2:DOCTOR OF BEHAVIORAL HEALTH, ARIZONA STATE UNIVERSITY
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2135
Mailing Address - Country:US
Mailing Address - Phone:602-496-1355
Mailing Address - Fax:602-496-1597
Practice Address - Street 1:500 N. 3RD STREET MAIL CODE 3320
Practice Address - Street 2:DOCTOR OF BEHAVIORAL HEALTH, ARIZONA STATE UNIVERSITY
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2135
Practice Address - Country:US
Practice Address - Phone:602-496-1355
Practice Address - Fax:602-496-1597
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT 359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist