Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 012395-1 | NY |
N | 103T00000X | Psychologist | 012395-1 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 012395-1 | NY |
Y | 103G00000X | Clinical Psychologist | 012395-1 | NY |
Y | 103TC0700X | Clinical Psychologist | 012395-1 | NY |
NPI | 1174087753 |
---|---|
Provider Name | Dr. Joan Anne Mackell |
First Address | Douglas Manor, NY 11363-1107 |
Second Address | Douglas Manor, NY 11363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2019 |
Last Update Date | 11/06/2019 |