Provider Demographics
NPI:1063660835
Name:MACKEY, ROBINNE SUE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBINNE
Middle Name:SUE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 AIRPORT DR
Mailing Address - Street 2:SUITE 253
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2652
Mailing Address - Country:US
Mailing Address - Phone:505-325-2778
Mailing Address - Fax:505-325-6171
Practice Address - Street 1:501 AIRPORT DR.
Practice Address - Street 2:ST. 253
Practice Address - City:FARMINGTON
Practice Address - State:IL
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-325-2778
Practice Address - Fax:505-325-6171
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-05522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95937Medicaid
NM85-0375998OtherFEDERAL TAX I.D.