Provider Demographics
NPI:1578211926
Name:SAGE-MCLEAN KINDNESS CARE LCSW, PLLC
Entity Type:Organization
Organization Name:SAGE-MCLEAN KINDNESS CARE LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAGE-MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:315-760-8651
Mailing Address - Street 1:143 MCLEAN LN
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:NY
Mailing Address - Zip Code:13778-2214
Mailing Address - Country:US
Mailing Address - Phone:607-352-4465
Mailing Address - Fax:315-802-7670
Practice Address - Street 1:143 MCLEAN LN
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:NY
Practice Address - Zip Code:13778-2214
Practice Address - Country:US
Practice Address - Phone:607-352-4465
Practice Address - Fax:315-802-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03181899Medicaid