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General NPI Number Information
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NPI Number | 1114415775
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Entity Type | Individual
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Provider Name | CAROL JOAN MCKINNEY LMSW, CASAC-T
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Gender | Female
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Dates
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Enumeration Date | 04/28/2018
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Last Update Date | 04/28/2018
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Provider Practice Location Address
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Address Line | 37 JOHN ST
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City | AMITYVILLE
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State | NY
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Zip | 11701-2930
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Country | US
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Telephone | 631-424-2900
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Fax | 631-608-1057
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Provider Business Mailing Address
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Address Line | 46 WALTER AVE
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City | HICKSVILLE
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State | NY
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Zip | 11801-5345
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Country | US
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Telephone | 646-404-4061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 103448
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 103448
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 103448
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 103448
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 103448
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 103448
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License Number State | NY
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Taxonomy #7
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 103448
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License Number State | NY
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