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General NPI Number Information
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NPI Number | 1437764735
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Entity Type | Individual
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Provider Name | MACKENZIE CARA WILSON
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Gender | Female
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 31 6TH ST
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City | MALONE
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State | NY
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Zip | 12953-1246
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Country | US
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Telephone | 518-483-3261
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Fax | 518-483-3383
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Provider Business Mailing Address
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Address Line | 1245 COUNTY ROUTE 25
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City | MALONE
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State | NY
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Zip | 12953-6023
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Country | US
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Telephone | 518-483-3261
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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