Provider Demographics
NPI:1376163949
Name:MACKINTOSH, MAGGIE (MA, RBT, LBS)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:MACKINTOSH
Suffix:
Gender:F
Credentials:MA, RBT, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 NAZARETH PIKE
Mailing Address - Street 2:SUITE 22A
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:224 NAZARETH PIKE
Practice Address - Street 2:SUITE 22A
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064
Practice Address - Country:US
Practice Address - Phone:610-365-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst