Provider Demographics
NPI:1578215216
Name:MARTINS, MACKENZIE (MS, BCBA, LABA)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:MARTINS
Suffix:
Gender:F
Credentials:MS, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 POND ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1627
Mailing Address - Country:US
Mailing Address - Phone:774-929-5919
Mailing Address - Fax:
Practice Address - Street 1:218 WILLARD ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1518
Practice Address - Country:US
Practice Address - Phone:781-421-6182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3783103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst