Provider Demographics
NPI:1437841079
Name:HETU, MAKENZIE ANN
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:ANN
Last Name:HETU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CAMARDO DR
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1870
Mailing Address - Country:US
Mailing Address - Phone:617-688-3952
Mailing Address - Fax:
Practice Address - Street 1:3057 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-3636
Practice Address - Country:US
Practice Address - Phone:508-742-1040
Practice Address - Fax:508-990-0281
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA314693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health