Provider Demographics
NPI:1619690153
Name:DEMPSEY, MYKEYAH (MS NCC)
Entity Type:Individual
Prefix:
First Name:MYKEYAH
Middle Name:
Last Name:DEMPSEY
Suffix:
Gender:F
Credentials:MS NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18706-2801
Mailing Address - Country:US
Mailing Address - Phone:570-793-3425
Mailing Address - Fax:
Practice Address - Street 1:21 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3801
Practice Address - Country:US
Practice Address - Phone:570-301-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAZAV118733896001OtherHIGHMARK BLUE SHIELD