Healthcare Provider Details

I. General information

NPI: 1518046960
Provider Name (Legal Business Name): AMY ELLIS MCCRACKEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELLIS MCCRACKEN LCSW

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 GOLDEN HILL LN ULSTER COUNTY MENTAL HEALTH DEPARTMENT
KINGSTON NY
12401-6441
US

IV. Provider business mailing address

239 GOLDEN HILL LN ULSTER COUNTY MENTAL HEALTH DEPARTMENT
KINGSTON NY
12401-6441
US

V. Phone/Fax

Practice location:
  • Phone: 845-340-4179
  • Fax: 845-340-4094
Mailing address:
  • Phone: 845-340-4179
  • Fax: 845-340-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR039755
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: