Provider Demographics
NPI:1881146603
Name:MCCLOSKEY, JOHN (PHD,)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCCLOSKEY
Suffix:
Gender:M
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-1001
Mailing Address - Country:US
Mailing Address - Phone:518-747-2994
Mailing Address - Fax:518-747-2996
Practice Address - Street 1:15 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1001
Practice Address - Country:US
Practice Address - Phone:518-747-2994
Practice Address - Fax:518-747-2996
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009906-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical