Provider Demographics
NPI:1487489274
Name:CARTER, MACKENZIE K
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:K
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LONG POINT RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-2123
Mailing Address - Country:US
Mailing Address - Phone:508-264-3375
Mailing Address - Fax:
Practice Address - Street 1:10 LONG POINT RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-2123
Practice Address - Country:US
Practice Address - Phone:508-264-3375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician