Provider Demographics
NPI:1356906382
Name:MACKAY, KAITLIN (BCBA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:MACKAY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-1643
Mailing Address - Country:US
Mailing Address - Phone:413-663-1960
Mailing Address - Fax:
Practice Address - Street 1:216 W BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1784
Practice Address - Country:US
Practice Address - Phone:978-790-5793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2661103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst