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General NPI Number Information
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NPI Number | 1467725598
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Entity Type | Individual
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Provider Name | MACKENZIE JOE MILNER M.S.ED., BCBA
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Gender | Female
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 75 CENTRE OF NEW ENGLAND BLVD
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City | COVENTRY
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State | RI
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Zip | 02816-6067
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Country | US
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Telephone | 401-617-2775
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Fax | 401-615-2881
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Provider Business Mailing Address
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Address Line | 155 GEORGIA AVE
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-6000
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Country | US
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Telephone | 401-241-0333
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-08-3996
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License Number State | RI
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