Provider Demographics
NPI:1306957998
Name:MCCLOSKEY, VICKI LEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:LEE
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 LIBERTY HILL RD
Mailing Address - Street 2:BLDG 2 SUITE 214
Mailing Address - City:HENNIKER
Mailing Address - State:NH
Mailing Address - Zip Code:03242-3067
Mailing Address - Country:US
Mailing Address - Phone:603-428-6611
Mailing Address - Fax:
Practice Address - Street 1:41 LIBERTY HILL RD
Practice Address - Street 2:BUILDING 2 SUITE 214
Practice Address - City:HENNIKER
Practice Address - State:NH
Practice Address - Zip Code:03242-3067
Practice Address - Country:US
Practice Address - Phone:603-428-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH874103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422003Medicare ID - Type Unspecified