Provider Demographics
NPI:1053657866
Name:MCKENZIE, PRUDENCE ANCHETA (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:PRUDENCE
Middle Name:ANCHETA
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:PRUDENCE
Other - Middle Name:ANCHETA
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:12 STUYVESANT OVAL APT 12F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2215
Mailing Address - Country:US
Mailing Address - Phone:212-673-5400
Mailing Address - Fax:212-673-5440
Practice Address - Street 1:12 STUYVESANT OVAL APT 12F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2215
Practice Address - Country:US
Practice Address - Phone:212-673-5400
Practice Address - Fax:212-673-5440
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004368-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health