Provider Demographics
NPI:1164747796
Name:MACKINNON, STEPHEN HUGH
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HUGH
Last Name:MACKINNON
Suffix:
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 1:155 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-2649
Mailing Address - Country:US
Mailing Address - Phone:413-747-0829
Mailing Address - Fax:413-747-7804
Practice Address - Street 1:417 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3736
Practice Address - Country:US
Practice Address - Phone:413-736-3668
Practice Address - Fax:413-731-8651
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health