Provider Demographics
NPI:1114362811
Name:AMORE-MACKNEY, JOANNA ROSE
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:ROSE
Last Name:AMORE-MACKNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:ROSE
Other - Last Name:AMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 CORONADO ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1128
Mailing Address - Country:US
Mailing Address - Phone:516-610-7900
Mailing Address - Fax:
Practice Address - Street 1:126 CORONADO ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11509-1128
Practice Address - Country:US
Practice Address - Phone:516-610-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335725780252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency