1285635938 NPI number — MS. PATRICIA M. MACKEY LCSWR,CASAC

Table of content: MS. PATRICIA M. MACKEY LCSWR,CASAC (NPI 1285635938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285635938 NPI number — MS. PATRICIA M. MACKEY LCSWR,CASAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACKEY
Provider First Name:
PATRICIA
Provider Middle Name:
M.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR,CASAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIMBLE
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSWR,CASAC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285635938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/31/2006
NPI Reactivation Date:
04/03/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1068 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
FISHKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12524-3664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-235-2848
Provider Business Mailing Address Fax Number:
845-896-1587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1068 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
FISHKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12524-3664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-235-2848
Provider Business Practice Location Address Fax Number:
845-896-1587
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  4503 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: R048975 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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