Provider Demographics
NPI:1093306318
Name:O'CONNOR, MCKENZIE (MS)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 S FEDERAL HWY APT G
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-8813
Mailing Address - Country:US
Mailing Address - Phone:561-727-9006
Mailing Address - Fax:
Practice Address - Street 1:12300 S SHORE BLVD STE 218
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6509
Practice Address - Country:US
Practice Address - Phone:561-877-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health