Individual
NINA S. MACKTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
40 WATCH HILL WAY, WAKEFIELD, RI 02879-7692
(401) 792-3664
Mailing address
40 WATCH HILL WAY, WAKEFIELD, RI 02879-7692
(401) 331-1350
(401) 277-3366
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW01136
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31708-9
BLUE CROSS BLUE SHIELD
—
01
—
413619
BLUE CHIP
—
Enumeration date
09/02/2006
Last updated
04/11/2008
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