MEDICARE: MACKENZIE R FARMER

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
1	106E00000X	Assistant Behavior Analyst		VA

General Provider Information

NPI Number	:	1386506228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE R FARMER

Provider Business Mailing Address
First Line	:	10123 CHESWICK CT
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-6076
Country	:	US
Telephone Number	:	703-479-9926
Fax Number	:

Provider Business Practice Location Address
First Line	:	9994 SOWDER VILLAGE SQ # 102
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20109-5464
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ MACKENZIE R FARMER ” Practice Location

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