Provider Demographics
NPI:1952022048
Name:MACKIN, KATELYN (LMSW)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:MACKIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WOODCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:STORMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12582-5717
Mailing Address - Country:US
Mailing Address - Phone:845-279-2995
Mailing Address - Fax:
Practice Address - Street 1:400 DOANSBURG RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-5902
Practice Address - Country:US
Practice Address - Phone:845-279-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker