Healthcare Provider Details

I. General information

NPI: 1881601292
Provider Name (Legal Business Name): JOSEPH MC KAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 GLEN ST
GLENS FALLS NY
12801-2230
US

IV. Provider business mailing address

498 GLEN ST
GLENS FALLS NY
12801-2230
US

V. Phone/Fax

Practice location:
  • Phone: 518-743-9099
  • Fax:
Mailing address:
  • Phone: 518-743-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073932
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: