Provider Demographics
NPI:1982113270
Name:BARTOLI, MACKENZIE RAENA (BCBA)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RAENA
Last Name:BARTOLI
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 1:201 ROYAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-2040
Mailing Address - Country:US
Mailing Address - Phone:616-970-4172
Mailing Address - Fax:
Practice Address - Street 1:126 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1736
Practice Address - Country:US
Practice Address - Phone:616-970-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst