Stacey Jo Mackaman, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

146799 Issued in CA

Practice address

225 Avenue I Ste 204
Redondo Beach, CA 90277-5608

Phone

(424) 903-6520

Fax

(424) 772-6993

NPI assigned

Jan 23, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Stacey Jo Montgomery Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Q Psychology Group, a Psychological Corporation

  • Clinical Psychologist
  • Redondo Beach, CA
  • NPI 1649733866
  NPD

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

{
    "created_epoch": "1642896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1437801230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 ARDMORE AVE",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902545229",
            "telephone_number": "312-758-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 AVENUE I STE 204",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902775608",
            "telephone_number": "424-903-6520",
            "fax_number": "424-772-6993"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "170 Ardmore Ave",
            "address_purpose": "LOCATION",
            "city": "Hermosa Beach",
            "state": "CA",
            "postal_code": "902545229",
            "country_code": "US",
            "telephone_number": "312-758-2428",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1230 Rosecrans Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "Manhattan Beach",
            "state": "CA",
            "postal_code": "902662494",
            "country_code": "US",
            "telephone_number": "424-903-6520",
            "fax_number": "424-772-6993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKAMAN",
        "first_name": "STACEY",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-23",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "146799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "MONTGOMERY",
            "middle_name": "JO",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Caleb Frederick Lynch, PHARMD
• Sean Lynn
• Grace Ma, OD
• Marta Maaza, RN
• Matthew Macgugan
• Mona Madani, M.D.
• Madison Park Family Medical
• Madison Park Family Medical Group
• Madison Park Family Medical Group, Inc.
• Malina Maeda

• Marriage & Family Therapist in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.