Provider Demographics
NPI:1720655053
Name:MACKAY, ANGELA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MACKAY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:MACKAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, APRN, PMHNP-BC
Mailing Address - Street 1:8000 JUMPERS HOLE RD STE 217
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1046
Mailing Address - Country:US
Mailing Address - Phone:240-883-4025
Mailing Address - Fax:410-415-3722
Practice Address - Street 1:8000 JUMPERS HOLE RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1036
Practice Address - Country:US
Practice Address - Phone:240-883-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224907363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty