Provider Demographics
NPI:1639252281
Name:MCNALLY, KATHLEEN BROWN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BROWN
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 W END AVE
Mailing Address - Street 2:C12K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7853
Mailing Address - Country:US
Mailing Address - Phone:516-313-0060
Mailing Address - Fax:
Practice Address - Street 1:75 W END AVE
Practice Address - Street 2:C12K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7853
Practice Address - Country:US
Practice Address - Phone:516-313-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046916-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN8M081Medicare PIN