Basic Information
| Provider Information | |||||||||
| NPI: | 1992315147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAXLEY | ||||||||
| FirstName: | MACKENZIE | ||||||||
| MiddleName: | LUNA | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 132 6TH ST APT 3 | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014530068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788334270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 360 MERRIMACK ST | ||||||||
| Address2: | BLDG 9, ENT. H | ||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786884830 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2020 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.