Active NPI
Jeremy Mackenzie
- Behavior Analyst
- Boston, MA
National Provider Identifier
1871034660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 000001531
- Practice address
- 12 Chelmsford St
Boston, MA 02122-2104 - Phone
- (781) 248-3802
- NPI assigned
- Mar 14, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 000001531 | MA | Primary |
Addresses
Primary practice location
12 Chelmsford St
Boston, MA 02122-2104
Mailing address
12 Chelmsford St
Boston, MA 02122-2104
Phone (781) 248-3802
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1-16-23544 | Other | MA | BACB CERTIFICATION NUMBER |
| 000001531 | Other | MA | LABA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000001531 | MA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489449600000",
"number": "1871034660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 CHELMSFORD ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021222104",
"telephone_number": "781-248-3802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 CHELMSFORD ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021222104",
"telephone_number": "781-248-3802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKENZIE",
"first_name": "JEREMY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-14",
"last_updated": "2017-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MA",
"license": "000001531",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BACB CERTIFICATION NUMBER",
"identifier": "1-16-23544",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABA",
"identifier": "000001531",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.