Provider Demographics
NPI:1154867380
Name:BARNARD, MACKENZIE (RBT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:BARNARD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12323 RENNER RD
Mailing Address - Street 2:
Mailing Address - City:KEYMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21757-5012
Mailing Address - Country:US
Mailing Address - Phone:443-812-5254
Mailing Address - Fax:
Practice Address - Street 1:1003 WEST 7TH STREET SUITE 500
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701
Practice Address - Country:US
Practice Address - Phone:301-345-1022
Practice Address - Fax:301-560-5558
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8704101YP2500X
MD1-18-33609103K00000X
0000000000000106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician