Provider Demographics
NPI:1033455415
Name:MCKENZIE, LORRAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:KERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1292 HIGH ST STE 144
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3238
Mailing Address - Country:US
Mailing Address - Phone:458-215-0719
Mailing Address - Fax:541-543-2212
Practice Address - Street 1:1292 HIGH ST STE 144
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3238
Practice Address - Country:US
Practice Address - Phone:458-215-0179
Practice Address - Fax:541-543-2212
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORM6689101YM0800X
ORL66891041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500689849Medicaid