Provider Demographics
NPI:1255760963
Name:MACKIN, GINA (LCSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MACKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SAVANNAH GARDNER RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-5544
Mailing Address - Country:US
Mailing Address - Phone:724-272-0179
Mailing Address - Fax:
Practice Address - Street 1:101 SAVANNAH GARDNER RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-5544
Practice Address - Country:US
Practice Address - Phone:724-272-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-03
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0178141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical