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General NPI Number Information
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NPI Number | 1952946253
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Entity Type | Individual
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Provider Name | KAITLYN RENEE MACKEY MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 11/10/2019
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 105 E KING ST
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City | LANCASTER
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State | PA
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Zip | 17602-2803
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Country | US
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Telephone | 717-397-0156
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Fax | 717-397-1782
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Provider Business Mailing Address
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Address Line | 33 ROLLINS LN
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City | WILLOW STREET
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State | PA
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Zip | 17584-8606
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Country | US
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Telephone | 717-725-5908
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW137321
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | NA
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License Number State | PA
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