Healthcare Provider Details

I. General information

NPI: 1568397727
Provider Name (Legal Business Name): MOIRA GRACE MACKEY MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LIBERTY ST
EASTHAMPTON MA
01027-1448
US

IV. Provider business mailing address

5 MEADOWOOD DR
SOUTH HADLEY MA
01075-1310
US

V. Phone/Fax

Practice location:
  • Phone: 413-540-1234
  • Fax: 413-538-5169
Mailing address:
  • Phone: 413-285-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: