Provider Demographics
NPI:1528771391
Name:MCKEVITT, PAISLEY JADE
Entity type:Individual
Prefix:MS
First Name:PAISLEY
Middle Name:JADE
Last Name:MCKEVITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BOYD ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2516
Mailing Address - Country:US
Mailing Address - Phone:516-509-4296
Mailing Address - Fax:
Practice Address - Street 1:63 BOYD ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2516
Practice Address - Country:US
Practice Address - Phone:516-509-4296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker