Provider Demographics
NPI:1407238496
Name:ALBERT, MACKENZIE LEE (MAED)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LEE
Last Name:ALBERT
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2746
Mailing Address - Country:US
Mailing Address - Phone:585-473-2858
Mailing Address - Fax:585-461-3771
Practice Address - Street 1:941 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2746
Practice Address - Country:US
Practice Address - Phone:585-473-2858
Practice Address - Fax:585-461-3771
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist