Provider Demographics
NPI:1124189261
Name:MACKENZIE, JUNE (LRC LADC I)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:LRC LADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 WALTHAM STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8033
Mailing Address - Country:US
Mailing Address - Phone:781-862-3600
Mailing Address - Fax:781-863-5904
Practice Address - Street 1:742 MASSACHUSETTS AVENUE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4712
Practice Address - Country:US
Practice Address - Phone:781-646-7301
Practice Address - Fax:781-643-8726
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1004745OtherBEACON HEALTH
MAM18633OtherBCBS
MA1303287OtherMBHP
MA703136OtherTUFTS
MANP01332OtherBOSTON MED
MA1303287Medicaid
MA99618201OtherNETWORK HLTH
MAY10074Medicare ID - Type Unspecified