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Individual

AMY MACKEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CIT

Contact information

Practice address
526 OLD LIVERPOOL RD, LIVERPOOL, NY 13088-6238
(315) 453-3911
(315) 453-0197
Mailing address
79 GLENRIDGE RD, GLENVILLE, NY 12302-4523
(518) 952-8408
(518) 952-8287

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01420800
NY
05
03008275
NY
Enumeration date
06/12/2013
Last updated
12/22/2016
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