Provider Demographics
NPI:1962816645
Name:MACKEY, CATHLEEN (MS ED)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ROLLING MEADOWS ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-7062
Mailing Address - Country:US
Mailing Address - Phone:917-291-6451
Mailing Address - Fax:
Practice Address - Street 1:101 ROLLING MEADOWS ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7062
Practice Address - Country:US
Practice Address - Phone:917-291-6451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1642793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist