Provider Demographics
NPI:1609200260
Name:CUDDY, MACKENZIE FAY
Entity Type:Individual
Prefix:MISS
First Name:MACKENZIE
Middle Name:FAY
Last Name:CUDDY
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 1:555 AMORY ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2652
Mailing Address - Country:US
Mailing Address - Phone:774-254-5134
Mailing Address - Fax:
Practice Address - Street 1:555 AMORY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2652
Practice Address - Country:US
Practice Address - Phone:774-254-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker