Michael W Mackie PHD a Professional Corp

Primary specialty

Forensic PsychologistTaxonomy code 103TF0200X

Legal business name

MICHAEL W MACKIE PHD A PROFESSIONAL CORP

Practice address

10700 Santa Monica Blvd Ste 300
Los Angeles, CA 90025-6587

Phone

(424) 465-2840

NPI assigned

Jan 29, 2024

Last updated

Jan 29, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael William Vincent Mackie Jr., PHDNPI 1851881379

Title

Owner Provider

Phone

(424) 465-2840

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael William Vincent Mackie, PH.D

  • Clinical Psychologist
  • Los Angeles, CA
  • NPI 1851881379
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706486400000",
    "number": "1174385892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10700 SANTA MONICA BLVD STE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900256587",
            "telephone_number": "424-465-2840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10700 SANTA MONICA BLVD STE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900256587",
            "telephone_number": "424-465-2840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL W MACKIE PHD A PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-29",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-28",
        "status": "A",
        "authorized_official_last_name": "MACKIE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WILLIAM VINCENT",
        "authorized_official_title_or_position": "OWNER PROVIDER",
        "authorized_official_telephone_number": "424-465-2840",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael W Gettis Optometric Corporation
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• Aden Michael, LCSW
• Bethlehem Simon Michael, MD
• Eric Michael, M.D.
• Judith A Michael

• Forensic Psychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Forensic Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.