Provider Demographics
NPI:1043741226
Name:MACNEIL, EDWARD JR
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:MACNEIL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2073
Mailing Address - Country:US
Mailing Address - Phone:508-410-0476
Mailing Address - Fax:
Practice Address - Street 1:55 ARCH ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2073
Practice Address - Country:US
Practice Address - Phone:508-410-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health