Provider Demographics
NPI:1679777114
Name:MACROY, KATHLEEN ANN (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:MACROY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1840
Mailing Address - Country:US
Mailing Address - Phone:716-372-9344
Mailing Address - Fax:716-372-9497
Practice Address - Street 1:2438 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1840
Practice Address - Country:US
Practice Address - Phone:716-372-9344
Practice Address - Fax:716-372-9497
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074319-1101YM0800X
NY0782791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00635098Medicaid
NY03459285Medicaid
NYJ400053397Medicare PIN
NYJ400069582Medicare PIN