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NPI Code Detail

MEDICARE: SUSANNAH DOROTHY AQUIN MACKAYE LCSW

MEDICARE: SUSANNAH DOROTHY AQUIN MACKAYE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCS20377CA

General Provider Information

NPI Number : 1356533236
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSANNAH DOROTHY AQUIN MACKAYE LCSW
Provider Business Mailing Address
First Line : 409 JACKSON ST
Second Line :
City : HAYWARD
State : CA
Zip : 94544-1530
Country : US
Telephone Number : 510-891-5600
Fax Number :
Provider Business Practice Location Address
First Line : 409 JACKSON ST
Second Line :
City : HAYWARD
State : CA
Zip : 94544-1530
Country : US
Telephone Number : 510-891-5545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2007
Last Update Date : 10/25/2023

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Directions to “ SUSANNAH DOROTHY AQUIN MACKAYE LCSW” Practice Location

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