Provider Demographics
NPI:1174087753
Name:MACKELL, JOAN ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:ANNE
Last Name:MACKELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:ANNE
Other - Last Name:O'HANDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 HOLLYWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1107
Mailing Address - Country:US
Mailing Address - Phone:917-543-5751
Mailing Address - Fax:
Practice Address - Street 1:7 HOLLYWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:DOUGLAS MANOR
Practice Address - State:NY
Practice Address - Zip Code:11363
Practice Address - Country:US
Practice Address - Phone:917-543-5751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012395-1103T00000X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral