Macculloch, Mary Angela

Macculloch, Mary Angela is an individual health care provider with primary practice located at 11050 Mount Belvedere Blvd , Fort Drum NY 13602-5438. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Social Worker. Behavioral Health & Social Service Providers / Social Worker is her primary health care specialty. Macculloch, Mary Angela can be contacted via phone (315) 772-7624.

Contact Information

Primary practice address
11050 Mount Belvedere Blvd Fort Drum NY 13602-5438
Phone: (315) 772-7624
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 075757-1 New York
Behavioral Health & Social Service Providers / Social Worker 104100000X

Profile Details

NPI number 1023369675
LBN Legal business name Macculloch, Mary Angela
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 23rd, 2012
Last updated Oct 25th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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