Individual
JEREMY MACKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12 CHELMSFORD ST, BOSTON, MA 02122-2104
(781) 248-3802
Mailing address
12 CHELMSFORD ST, BOSTON, MA 02122-2104
(781) 248-3802
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
000001531
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001531
LABA
MA
01
—
1-16-23544
BACB CERTIFICATION NUMBER
MA
Enumeration date
03/14/2017
Last updated
03/14/2017
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