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NPI Code Detail

MEDICARE: PATRICK MACKENNA CASAC-T

MEDICARE: PATRICK MACKENNA CASAC-T
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor20011NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120011OTHERNYCASAC-T

General Provider Information

NPI Number : 1891868162
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK MACKENNA CASAC-T
Provider Business Mailing Address
First Line : 425 MICHIGAN AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14203-2209
Country : US
Telephone Number : 716-848-2000
Fax Number : 716-848-2112
Provider Business Practice Location Address
First Line : 425 MICHIGAN AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14203-2209
Country : US
Telephone Number : 716-848-2000
Fax Number : 716-848-2112
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 01/24/2011

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Directions to “ PATRICK MACKENNA CASAC-T” Practice Location

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