Provider Demographics
NPI:1417579707
Name:SQUIERS, MCKENNA
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:SQUIERS
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 1:16 SQUIERS ALY
Mailing Address - Street 2:
Mailing Address - City:NOBLEBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04555-9604
Mailing Address - Country:US
Mailing Address - Phone:207-656-2415
Mailing Address - Fax:
Practice Address - Street 1:16 SQUIERS ALY
Practice Address - Street 2:
Practice Address - City:NOBLEBORO
Practice Address - State:ME
Practice Address - Zip Code:04555-9604
Practice Address - Country:US
Practice Address - Phone:207-656-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst