Provider Demographics
NPI:1114257904
Name:MCKENZIE, ODILE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ODILE
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 CROWN STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5442
Mailing Address - Country:US
Mailing Address - Phone:718-363-0100
Mailing Address - Fax:718-363-3005
Practice Address - Street 1:738 CROWN STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5442
Practice Address - Country:US
Practice Address - Phone:718-363-1011
Practice Address - Fax:718-363-3005
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0817711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical