Provider Demographics
NPI:1134183569
Name:MACKAY, NANCY (PSYD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:MACKAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 MICHIGAN AVE
Mailing Address - Street 2:SUITE J-2
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-5758
Mailing Address - Country:US
Mailing Address - Phone:321-639-4483
Mailing Address - Fax:321-690-0848
Practice Address - Street 1:1970 MICHIGAN AVE
Practice Address - Street 2:SUITE J-2
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-5758
Practice Address - Country:US
Practice Address - Phone:321-639-4483
Practice Address - Fax:321-690-0848
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004573103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73911ZMedicare ID - Type Unspecified