Provider Demographics
NPI:1619320124
Name:MACKINNON, JULIANNE (MED, EDS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:MED, EDS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CALYPSO LANE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050
Mailing Address - Country:US
Mailing Address - Phone:508-847-5730
Mailing Address - Fax:
Practice Address - Street 1:77 CALYPSO LN
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-3601
Practice Address - Country:US
Practice Address - Phone:508-847-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABACB236895103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst