Provider Demographics
NPI:1578150439
Name:DOROTHY MACK, LICSW LLC
Entity Type:Organization
Organization Name:DOROTHY MACK, LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-281-0141
Mailing Address - Street 1:10 WENDELL AVENUE EXT STE 209
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6283
Mailing Address - Country:US
Mailing Address - Phone:413-281-0141
Mailing Address - Fax:
Practice Address - Street 1:10 WENDELL AVENUE EXT STE 209
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6283
Practice Address - Country:US
Practice Address - Phone:413-281-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health