Provider Demographics
NPI:1992561930
Name:MCCLOSKEY, MARK SIDNEY (LMSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:SIDNEY
Last Name:MCCLOSKEY
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 1:4955 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9389
Mailing Address - Country:US
Mailing Address - Phone:315-729-4788
Mailing Address - Fax:
Practice Address - Street 1:447 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1020
Practice Address - Country:US
Practice Address - Phone:585-295-7836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116303104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker