Provider Demographics
NPI:1194036996
Name:LERARIO, MACKENZIE PAIGE (MD, LMSW)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:PAIGE
Last Name:LERARIO
Suffix:
Gender:F
Credentials:MD, LMSW
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:PAUL
Other - Last Name:LERARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:603 W 140TH ST APT 44
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7109
Mailing Address - Country:US
Mailing Address - Phone:914-705-1558
Mailing Address - Fax:212-746-8532
Practice Address - Street 1:603 W 140TH ST APT 44
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7109
Practice Address - Country:US
Practice Address - Phone:914-705-1558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2757602084V0102X
NJ44SL070342001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology