Provider Demographics
NPI:1508161464
Name:MCKENZIE, MAUREEN (CLINICIAN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:CLINICIAN
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STUDENT INTERN
Mailing Address - Street 1:622 STATE STREET
Mailing Address - Street 2:CENTER FOR HUMAN DEVELOPMENT
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109
Mailing Address - Country:US
Mailing Address - Phone:413-439-1207
Mailing Address - Fax:
Practice Address - Street 1:622 STATE ST
Practice Address - Street 2:622 STATE STREET
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4104
Practice Address - Country:US
Practice Address - Phone:413-439-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program