Provider Demographics
NPI:1699788489
Name:MACKIE, ALAN (LCSW)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:MACKIE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 COUNTY ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-4205
Mailing Address - Country:US
Mailing Address - Phone:845-800-9079
Mailing Address - Fax:845-294-3785
Practice Address - Street 1:1425 COUNTY ROUTE 1
Practice Address - Street 2:
Practice Address - City:WESTTOWN
Practice Address - State:NY
Practice Address - Zip Code:10998-4205
Practice Address - Country:US
Practice Address - Phone:845-800-9079
Practice Address - Fax:845-565-0142
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN66892Medicare ID - Type UnspecifiedMEDICARE NUMBER