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NPI Code Detail

MEDICARE: MACKENZIE CONDON

MEDICARE: MACKENZIE CONDON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154944403
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE CONDON
Provider Business Mailing Address
First Line : 142 E 16TH ST APT 12E
Second Line :
City : NEW YORK
State : NY
Zip : 10003-3507
Country : US
Telephone Number : 833-646-3222
Fax Number :
Provider Business Practice Location Address
First Line : 13100 W LISBON RD STE 600
Second Line :
City : BROOKFIELD
State : WI
Zip : 53005-2509
Country : US
Telephone Number : 833-646-3222
Fax Number : 833-646-3222
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2020
Last Update Date : 02/07/2024

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Directions to “ MACKENZIE CONDON ” Practice Location

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