Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | S91289793 | MA |
NPI | 1003492117 |
---|---|
Provider Name | Mackenzie Sadie King |
First Address | Woodland Hills, CA 91367-4976 |
Second Address | Concord, MA 01742-2761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2021 |
Last Update Date | 19/03/2021 |