Healthcare Provider Details

I. General information

NPI: 1932019676
Provider Name (Legal Business Name): MARYKATHLEEN CLASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATE CLASSEY

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 BAY RD
QUEENSBURY NY
12804-3012
US

IV. Provider business mailing address

763 COUNTY ROUTE 43
FORT EDWARD NY
12828-3921
US

V. Phone/Fax

Practice location:
  • Phone: 518-798-4496
  • Fax:
Mailing address:
  • Phone: 203-470-7093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: