Provider Demographics
NPI:1295378362
Name:MACNEILL, LINDSEY ANN
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ANN
Last Name:MACNEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOLLOWAY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1841
Mailing Address - Country:US
Mailing Address - Phone:774-294-2936
Mailing Address - Fax:
Practice Address - Street 1:3 HOLLOWAY BROOK RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1841
Practice Address - Country:US
Practice Address - Phone:774-294-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABACB425072106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician