Provider Demographics
NPI:1437442670
Name:MCKENZIE-ELLIOTT, SHERONDIA P (MSW)
Entity Type:Individual
Prefix:
First Name:SHERONDIA
Middle Name:P
Last Name:MCKENZIE-ELLIOTT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BIRCHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119-1828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1828
Practice Address - Country:US
Practice Address - Phone:413-747-0829
Practice Address - Fax:413-747-7804
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool