Provider Demographics
NPI:1952946253
Name:MACKEY, KAITLYN RENEE (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:RENEE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROLLINS LN
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-8606
Mailing Address - Country:US
Mailing Address - Phone:717-725-5908
Mailing Address - Fax:
Practice Address - Street 1:105 E KING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2803
Practice Address - Country:US
Practice Address - Phone:717-397-0156
Practice Address - Fax:717-397-1782
Is Sole Proprietor?:No
Enumeration Date:2019-11-10
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137321104100000X
PANA207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No104100000XBehavioral Health & Social Service ProvidersSocial Worker