Provider Demographics
NPI:1891868162
Name:MACKENNA, PATRICK (CASAC-T)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:MACKENNA
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-2209
Mailing Address - Country:US
Mailing Address - Phone:716-848-2000
Mailing Address - Fax:716-848-2112
Practice Address - Street 1:425 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2209
Practice Address - Country:US
Practice Address - Phone:716-848-2000
Practice Address - Fax:716-848-2112
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20011101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20011OtherCASAC-T