Basic Information
| Provider Information | |||||||||
| NPI: | 1184789448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACKAY | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MASS TEACHER CERTIFI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | RAYNHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089770766 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1115 WEST CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085590473 | ||||||||
| FaxNumber: | 5084275361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TM1800X | Y | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities |
No ID Information.