Provider Demographics
NPI:1548801129
Name:JAQUITH, MACKENZIE JO-ANE (MA, LBA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:JO-ANE
Last Name:JAQUITH
Suffix:
Gender:F
Credentials:MA, LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1428
Mailing Address - Country:US
Mailing Address - Phone:401-618-6991
Mailing Address - Fax:401-618-6995
Practice Address - Street 1:715 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1428
Practice Address - Country:US
Practice Address - Phone:401-618-6991
Practice Address - Fax:401-618-6995
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst