Provider Demographics
NPI:1073852802
Name:MCCAFFERTY, HALLIE
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:MCCAFFERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5325
Mailing Address - Country:US
Mailing Address - Phone:212-206-5200
Mailing Address - Fax:212-206-5277
Practice Address - Street 1:230 W 17TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5325
Practice Address - Country:US
Practice Address - Phone:212-206-5200
Practice Address - Fax:212-206-5277
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337780363LF0000X
NY402167363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily