Provider Demographics
NPI:1467725598
Name:MILNER, MACKENZIE JOE (MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JOE
Last Name:MILNER
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-6000
Mailing Address - Country:US
Mailing Address - Phone:401-241-0333
Mailing Address - Fax:
Practice Address - Street 1:75 CENTRE OF NEW ENGLAND BLVD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6067
Practice Address - Country:US
Practice Address - Phone:401-617-2775
Practice Address - Fax:401-615-2881
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1-08-3996103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst