Provider Demographics
NPI:1447379425
Name:MACKLES, GINNY (LMHC)
Entity Type:Individual
Prefix:
First Name:GINNY
Middle Name:
Last Name:MACKLES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LEDGEWOOD COMMONS
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546-1027
Mailing Address - Country:US
Mailing Address - Phone:914-762-7761
Mailing Address - Fax:
Practice Address - Street 1:24 LEDGEWOOD COMMONS
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:NY
Practice Address - Zip Code:10546-1027
Practice Address - Country:US
Practice Address - Phone:914-762-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health