Provider Demographics
NPI:1104461789
Name:MAC CORKINDALE, SEAN DUNCAN (LMSW)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:DUNCAN
Last Name:MAC CORKINDALE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NORTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2413
Mailing Address - Country:US
Mailing Address - Phone:631-371-3978
Mailing Address - Fax:
Practice Address - Street 1:20 NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2413
Practice Address - Country:US
Practice Address - Phone:631-371-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107254101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty