Healthcare Provider Details

I. General information

NPI: 1679777114
Provider Name (Legal Business Name): KATHLEEN ANN MACROY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 CONSTITUTION AVE
OLEAN NY
14760-1840
US

IV. Provider business mailing address

2438 CONSTITUTION AVE
OLEAN NY
14760-1840
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-9344
  • Fax: 716-372-9497
Mailing address:
  • Phone: 716-372-9344
  • Fax: 716-372-9497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number074319-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078279
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00635098
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier03459285
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: