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NPI Code Detail

MEDICARE: DR. JO ANN MACKINSON PSYCHOLOGIST

MEDICARE: DR. JO ANN MACKINSON PSYCHOLOGIST
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
1103TC0700XClinical Psychologist03455MD

General Provider Information

NPI Number : 1356996334
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JO ANN MACKINSON PSYCHOLOGIST
Provider Business Mailing Address
First Line : 8169 OLD MONTGOMERY RD
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21043-7940
Country : US
Telephone Number : 410-696-7449
Fax Number :
Provider Business Practice Location Address
First Line : 8169 OLD MONTGOMERY RD
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21043-7940
Country : US
Telephone Number : 410-696-7449
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2019
Last Update Date : 08/06/2019

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