Provider Demographics
NPI:1639271281
Name:MACKEY, GAIL RANEA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:RANEA
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 PALM DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2521
Mailing Address - Country:US
Mailing Address - Phone:321-626-5321
Mailing Address - Fax:321-777-7545
Practice Address - Street 1:610 PALM DR
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2521
Practice Address - Country:US
Practice Address - Phone:321-626-5321
Practice Address - Fax:321-777-7545
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW62331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8129Medicare ID - Type Unspecified