Provider Demographics
NPI:1871110270
Name:MACSISAK, RANDY PAUL
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:PAUL
Last Name:MACSISAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 CHEW ST STE 106
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3412
Mailing Address - Country:US
Mailing Address - Phone:610-799-7113
Mailing Address - Fax:610-663-3270
Practice Address - Street 1:451 CHEW ST STE 106
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3412
Practice Address - Country:US
Practice Address - Phone:610-799-7113
Practice Address - Fax:610-663-3270
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)