Provider Demographics
NPI:1285635938
Name:MACKEY, PATRICIA M (LCSWR,CASAC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:M
Last Name:MACKEY
Suffix:
Gender:F
Credentials:LCSWR,CASAC
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:M
Other - Last Name:KIMBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWR,CASAC
Mailing Address - Street 1:1068 MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3664
Mailing Address - Country:US
Mailing Address - Phone:845-235-2848
Mailing Address - Fax:845-896-1587
Practice Address - Street 1:1068 MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3664
Practice Address - Country:US
Practice Address - Phone:845-235-2848
Practice Address - Fax:845-896-1587
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2017-06-23
Deactivation Date:2006-03-31
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
NY4503101YA0400X
NYR0489751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN8M391Medicare PIN
NYR85770Medicare UPIN