Healthcare Provider Details

I. General information

NPI: 1699788489
Provider Name (Legal Business Name): ALAN MACKIE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 COUNTY ROUTE 1
WESTTOWN NY
10998-4205
US

IV. Provider business mailing address

1425 COUNTY ROUTE 1
WESTTOWN NY
10998-4205
US

V. Phone/Fax

Practice location:
  • Phone: 845-800-9079
  • Fax: 845-565-0142
Mailing address:
  • Phone: 845-800-9079
  • Fax: 845-294-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: