Provider Demographics
NPI:1952003840
Name:CHOUINARD, MACKENZIE JESSICA
Entity type:Individual
Prefix:MISS
First Name:MACKENZIE
Middle Name:JESSICA
Last Name:CHOUINARD
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 1:43 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3520
Mailing Address - Country:US
Mailing Address - Phone:413-507-4137
Mailing Address - Fax:
Practice Address - Street 1:43 GLEN ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3520
Practice Address - Country:US
Practice Address - Phone:413-507-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst