Kelly Ryan Mac Cormac

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

126 E Harvard Ave
Fresno, CA 93704-5326

Phone

(925) 899-6293

NPI assigned

Mar 24, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kel Mac Cormac Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1831776228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7339 N 1ST ST STE 105&110",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202954",
            "telephone_number": "916-740-1749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 E HARVARD AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937045326",
            "telephone_number": "925-899-6293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAC CORMAC",
        "first_name": "KELLY",
        "middle_name": "RYAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-24",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEL",
            "last_name": "MAC CORMAC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Marwan Maalouf, FNP-C
• Trudi Lynn Maaskant, P.T.
• Gidai Maaza, LMFT
• Rahel Maaza
• Ron Mabry
• Dalia Macabio
• Daphne Faye Ventura Macarine
• Sofonias N Macarine Jr.
• Macarius, Max & Daniel, LLC
• David William Macdonald, D.D.S.

• Behavior Technician in Fresno, CA
• Providers in Fresno, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.