Provider Demographics
NPI:1750303202
Name:MACKEY, KATHERINE CHRISTINE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:CHRISTINE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:5811 MOUNTAIN LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-3202
Mailing Address - Country:US
Mailing Address - Phone:315-656-2087
Mailing Address - Fax:315-366-2599
Practice Address - Street 1:138 NORTH COURT STREET
Practice Address - Street 2:MADISON COUNTY MENTAL HEALTH DEPARTMENT
Practice Address - City:WAMPSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13163
Practice Address - Country:US
Practice Address - Phone:315-366-2327
Practice Address - Fax:315-366-2599
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014948OtherLICENSE NUMBER
NY014948OtherLICENSE NUMBER