Individual
MS. MERCEDES MACKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
254 W MAIN ST, WATERTOWN, NY 13601-1912
(315) 244-1655
Mailing address
254 W MAIN ST, WATERTOWN, NY 13601-1912
(315) 244-1655
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
469733
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
469733
TRI-CARE
NY
Enumeration date
12/16/2017
Last updated
12/16/2017
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