Provider Demographics
NPI:1548305253
Name:MCKINNY, PATRICIA MARIE (LICENSED MENTAL HEAL)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:MCKINNY
Suffix:
Gender:F
Credentials:LICENSED MENTAL HEAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6923 ROTTERDAM RD
Mailing Address - Street 2:
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551
Mailing Address - Country:US
Mailing Address - Phone:315-483-6068
Mailing Address - Fax:
Practice Address - Street 1:1519 NYE ROAD
Practice Address - Street 2:WAYNE BEHAVIORAL HEALTH NETWORK
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489
Practice Address - Country:US
Practice Address - Phone:315-946-5722
Practice Address - Fax:315-946-7066
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000936101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health