Provider Demographics
NPI:1871854158
Name:SMITH, KATHERINE MACKEY (MS SPED)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MACKEY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 KENSINGTON PL
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3010
Mailing Address - Country:US
Mailing Address - Phone:315-380-4444
Mailing Address - Fax:
Practice Address - Street 1:140 KENSINGTON PL
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-3010
Practice Address - Country:US
Practice Address - Phone:315-380-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator